Bustamante Brittany L Morgan, Miglioretti Diana, Keegan Theresa, Stewart Eric, Shrestha Anshu, Yang Nuen Tsang, Cress Rosemary D, Carvajal-Carmona Luis, Dang Julie, Fejerman Laura
University of California Berkeley, Berkely, CA, USA.
University of California Davis, Davis, CA, USA.
Cancer Causes Control. 2025 Apr;36(4):369-377. doi: 10.1007/s10552-024-01943-8. Epub 2024 Dec 1.
To describe the area-level rate of breast cancers, the percentage of early-stage diagnoses (stage I-IIa), and associations between area-level measures of poverty, racial/ethnic composition, primary care shortage, and urban/rural/frontier status for the UC Davis Comprehensive Cancer Center (UCDCCC) catchment area.
Using data from the SEER Cancer Registry of Greater California (2014-2018) and the California Department of Health Care Access and Information Medical Service Study Area, we conducted an ecological study in the UCDCCC catchment area to identify geographies that need screening interventions and their demographic characteristics.
The higher the percentage of the population identifying as Hispanic/Latino/Latinx, and the higher the percentage of the population below the 100% poverty level, the lower the odds of being diagnosed at an early-stage (OR = 0.98, 95% CI 0.96-0.99 and OR = 0.96, 95% CI 0.93-0.99, respectively). The association with poverty level was attenuated in the multivariable model when the Hispanic/Latino/Latinx population percentage was added. Several California counties had high poverty levels and differences in cancer stage distribution between racial/ethnic category groups. For all individuals combined, 65% was the lowest proportion of early-stage diagnoses for any geography. However, when stratified by racial/ethnic category, 11 geographies were below 65% for Hispanic/Latino/Latinx individuals, six for non-Hispanic Asian and Pacific Islander individuals, and seven for non-Hispanic African American/Black individuals, in contrast to one for non-Hispanic White individuals.
Areas with lower percentages of breast cancers diagnosed at an early-stage were characterized by high levels of poverty. Variation in the proportion of early-stage diagnosis was also observed by race/ethnicity where the proportion of Hispanic/Latino/Latinx individuals was associated with fewer early-stage diagnoses.
Results will inform the implementation of the UCDCCC mobile cancer prevention and early detection program, providing specific locations and populations to prioritize for tailored outreach, education, and screening.
描述加利福尼亚大学戴维斯分校综合癌症中心（UCDCCC）服务区域内乳腺癌的地区发病率、早期诊断（I-IIa期）的百分比，以及贫困程度、种族/族裔构成、初级保健短缺情况和城市/农村/偏远地区状况等地区层面指标之间的关联。
利用大加利福尼亚州监测、流行病学和最终结果（SEER）癌症登记处（2014 - 2018年）以及加利福尼亚州医疗保健获取与信息部医疗服务研究区域的数据，我们在UCDCCC服务区域开展了一项生态研究，以确定需要筛查干预的地区及其人口特征。
将自己认定为西班牙裔/拉丁裔/拉丁裔的人口比例越高，以及处于100%贫困线以下的人口比例越高，早期诊断的几率就越低（比值比分别为0.98，95%置信区间0.96 - 0.99和0.96，95%置信区间0.93 - 0.99）。当加入西班牙裔/拉丁裔/拉丁裔人口比例时，贫困程度与早期诊断几率之间的关联在多变量模型中有所减弱。加利福尼亚的几个县贫困程度较高，不同种族/族裔群体之间癌症分期分布存在差异。对于所有个体而言，任何地区早期诊断的最低比例为65%。然而，按种族/族裔类别分层时，西班牙裔/拉丁裔/拉丁裔个体中有11个地区低于65%，非西班牙裔亚裔和太平洋岛民个体中有6个地区，非西班牙裔非裔美国人/黑人个体中有7个地区，而非西班牙裔白人个体只有1个地区。
早期诊断出乳腺癌比例较低的地区，其贫困程度较高。按种族/族裔划分，早期诊断比例也存在差异，其中西班牙裔/拉丁裔/拉丁裔个体的早期诊断比例较低。
研究结果将为UCDCCC移动癌症预防和早期检测项目的实施提供参考，确定需要重点开展针对性外展、教育和筛查的具体地点和人群。
