Screening for breast cancer reduces mortality. Following the implementation of screening programs, European studies have shown that the incidence of early-stage and in situ breast cancers increased substantially. This was followed by a decline in the incidence of advanced-stage breast cancers, which approximated the size of the reduction in mortality rates. This pathway of effects towards mortality reduction resulting from screening would also be expected in the United States, but studies examining such reduction are currently lacking. Monitoring the effects of breast cancer screening in the United States among counties is clearly beneficial since this will facilitate local health planning and allocation of screening resources. Although screening use varies geographically, the extent to which changes over time in the effects of screening have varied among different counties in the United States is unclear. One explanation for the geographic variation in screening is that women from socioeconomically deprived areas are less likely to be screened. Because of the importance of physician recommendation to breast cancer screening and the mediating effect of primary care physician and mammography facility availability in the association between area deprivation and various health outcomes, we hypothesize that the differences in effect of breast cancer screening among counties with varying socioeconomic conditions will be mediated by the availability of primary care physicians and mammography facilities locally. In the second revision of this proposal, we will use an ecological study to: (1) Investigate the spatio-temporal variation of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality at the county-level using 1988-2005 data from nine SEER programs and 200 counties;(2) Determine the association of the county-specific variation of breast cancer screening prevalence with the county-specific incidence of advanced stage breast cancer and with breast cancer mortality;(3) Determine if temporal changes in early stage breast cancer, advanced stage breast cancer, and breast cancer mortality vary by county socioeconomic conditions;and (4) Determine if the availability of primary care physicians and mammography facilities at the county level explains the temporal differences between affluent and socioeconomically deprived counties in the incidence of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality. Bayesian methods will be used as part of spatio-temporal models.

Public Health Relevance

Monitoring the effects of breast cancer screening in the United States among counties is clearly beneficial since this will facilitate local health planning and allocation of screening resources. We will use an ecological study to: (1) Investigate the spatio-temporal variation of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality at the county-level using 1988-2005 data from nine SEER programs and 200 counties;(2) Determine the association of the county-specific variation of breast cancer screening prevalence with the county-specific incidence of advanced stage breast cancer and with breast cancer mortality;(3) Determine if temporal changes in early stage breast cancer, advanced stage breast cancer, and breast cancer mortality vary by county socioeconomic conditions;and (4) Determine if the availability of primary care physicians and mammography facilities at the county level explains the temporal differences between affluent and socioeconomically deprived counties in the incidence of early stage breast cancer, advanced stage breast cancer, and breast cancer mortality.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA109675-03
Application #
7869338
Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Breslau, Erica S
Project Start
2008-07-01
Project End
2013-06-30
Budget Start
2010-07-01
Budget End
2013-06-30
Support Year
3
Fiscal Year
2010
Total Cost
$344,722
Indirect Cost
Name
Washington University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Lian, Min; PĂ©rez, Maria; Liu, Ying et al. (2014) Neighborhood socioeconomic deprivation, tumor subtypes, and causes of death after non-metastatic invasive breast cancer diagnosis: a multilevel competing-risk analysis. Breast Cancer Res Treat 147:661-70
Chien, Lung-Chang; Yu, Hwa-Lung; Schootman, Mario (2013) Efficient mapping and geographic disparities in breast cancer mortality at the county-level by race and age in the U.S. Spat Spatiotemporal Epidemiol 5:27-37
Lian, Min; Struthers, James; Schootman, Mario (2012) Comparing GIS-based measures in access to mammography and their validity in predicting neighborhood risk of late-stage breast cancer. PLoS One 7:e43000
Chien, Lung-Chang; Deshpande, Anjali D; Jeffe, Donna B et al. (2012) Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis. PLoS One 7:e35737
Schootman, Mario; Lian, Min; Deshpande, Anjali D et al. (2010) Temporal trends in area socioeconomic disparities in breast-cancer incidence and mortality, 1988-2005. Breast Cancer Res Treat 122:533-43
Schootman, Mario; Lian, Min; Deshpande, Anjali D et al. (2010) Temporal trends in geographic disparities in small-area breast cancer incidence and mortality, 1988 to 2005. Cancer Epidemiol Biomarkers Prev 19:1122-31