Siegel Scott D, Zhang Yuchen, Budziszewski Ross, Bacchus Atif, Rowland Jennifer, Iacocca Mary V, Hall-Mcbride Robert, Curriero Frank C
Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States.
Center for Strategic Information Management, ChristianaCare, Newark, DE, United States.
JNCI Cancer Spectr. 2025 Jul 1;9(4). doi: 10.1093/jncics/pkaf067.
The National Cancer Institute (NCI) requires that NCI-Designated Cancer Centers develop programs to reduce the burden of cancer within their catchment areas, or the geographic area they serve. Extending catchment area approaches to community cancer centers has the potential to meaningfully reduce the burden of cancer nationwide. Building on a prior report that identified 2 advanced breast cancer (BC) hotspots (geographic areas with significantly elevated rates of BC) in a community cancer center catchment area, the objective of this study was to identify screening-related and tumor biology factors that explain the advanced BC hotspots.
Logistic regressions were used to model the relationship between BC screening interval and odds of advanced BC in a catchment area-based cohort of 3492 breast cancer patients, adjusting for demographic and tumor characteristics. The observed to expected case ratios were used to evaluate how well the regression models explained the hotspots.
In models adjusted for grade, molecular subtype, and histology, patients with inconsistent BC screening had more than twice the odds of advanced breast cancer as patients who screened regularly. The model largely explained one of the hotspots and approximately half of the excess cases observed for the second hotspot.
In a community cancer center catchment area, BC screening and tumor biology were associated with increased odds of advanced BC and helped to explain previously detected hotspots. Specific community outreach and engagement interventions are considered for these hotspots while broader implications for extending catchment area approaches to community cancer centers are discussed.
美国国立癌症研究所（NCI）要求被指定的癌症中心制定项目，以减轻其服务区域（即其服务的地理区域）内的癌症负担。将服务区域方法扩展到社区癌症中心有可能切实减轻全国范围内的癌症负担。基于之前一份报告，该报告在一个社区癌症中心服务区域内确定了2个晚期乳腺癌（BC）热点地区（BC发病率显著升高的地理区域），本研究的目的是确定解释晚期BC热点地区的筛查相关因素和肿瘤生物学因素。
采用逻辑回归模型，对3492名乳腺癌患者的基于服务区域的队列中BC筛查间隔与晚期BC几率之间的关系进行建模，并对人口统计学和肿瘤特征进行调整。观察到的与预期的病例比率用于评估回归模型对热点地区的解释程度。
在根据分级、分子亚型和组织学进行调整的模型中，BC筛查不一致的患者患晚期乳腺癌的几率是定期筛查患者的两倍多。该模型在很大程度上解释了其中一个热点地区，并解释了在第二个热点地区观察到的大约一半的额外病例。
在一个社区癌症中心服务区域内，BC筛查和肿瘤生物学与晚期BC几率增加相关，并有助于解释先前检测到的热点地区。针对这些热点地区考虑了具体的社区外展和参与干预措施，同时讨论了将服务区域方法扩展到社区癌症中心的更广泛意义。
