Older women living in the poorest areas of Appalachia in the U.S. fail to get regular breast cancer screening and have a higher incidence of later stage breast cancer, reports a new study in Health Services Research.
About 25 million people live in the 13 states that make up the Appalachian region, a 205,000-square-mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi. The National Cancer Institute has recently publicized Appalachia's higher rates of cancer and poorer outcomes for residents diagnosed with cancer.
To examine regional disparities in breast cancer screening and diagnosis, researchers evaluated Central Cancer Registry and Medicare claims data from three Appalachian states (Kentucky, Ohio, and Pennsylvania) to measure the incidence of later stage breast cancer in the region's poorest counties compared with its more affluent counties. The counties' economic statuses were compared based on factors such as unemployment rates, average home values and average monthly wages.
Women living in the most economically deprived counties—located in eastern Kentucky and southeastern Ohio—had 3.31 times as many late-stage tumors compared to those in the least deprived counties. Appalachian women in the study over age 65 had a 17.3 percent incidence of later stage breast cancer compared to a national average of 16 percent for women of the same age.
The degree of disparity between the counties was stronger than the researchers had suspected, said lead author Roger T. Anderson, Ph.D., from the department of public health science at Pennsylvania State University College of Medicine.
"Overall, we found counties that are struggling economically tend to have inadequate health care resources or infrastructure and have the highest rates of later-stage breast cancer," said Anderson.
There were also disparities in how often women received recommended mammography screening. Although area women over the age of 65 had Medicare insurance coverage, only 53 percent had mammography screening within the 2 years before their cancer diagnosis compared with the national average of 67 percent.
Anderson explained that counties that struggle economically may set up a "perpetuating cycle of few services to promote cancer prevention and early detection in communities and less overall use of preventive services."
Clement Gwede, Ph.D., associate director of diversity at the Moffitt Cancer Center in Tampa, agreed, saying that solutions to the disparities in late stage breast cancer in the nation's more distressed communities must include improved access to mammography screening resources, education and awareness, and related resources.
"Without these broad and sustained strategies, the vicious cycle will persist," Gwede added.
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Anderson, R. et al. Breast cancer screening, area deprivation, and later stage breast cancer in Appalachia: does geography matter, Health Services Research, 2013. onlinelibrary.wiley.com/journal/10.1111/(ISSN)1475-6773/