Transcript Document

Incorporating Multiple Evidence Sources for the Assessment of
Breast Cancer Policies and Practices
J. Jackson-Thompson, Gentry White, Missouri Cancer Registry, University of Missouri-Columbia;
M.J. King, Missouri Department of Health and Senior Services
Background:
•Breast cancer accounts for c. 1/3 of cancers among U.S. women.
Age-adjusted Invasive Female Breast Cancer
Incidence Rates, Missouri 1996-2002*
•Early detection and timely, appropriate treatment increase 5-year
survival.
133
128
•Lack of health insurance and low income are other factors
associated with lower survival.
123
118
White
Black
113
108
Purpose:
103
•To evaluate efforts to reduce breast cancer incidence and
mortality.
98
93
88
1996
White
Black
•To examine effectiveness of screening policies and practices.
1997
1998
1999
2000
2001
1997
1998
1999
2000
2001
2002
year
Methods:
Age-adjusted Incidence Rates* for Invasive Female Breast
Cancer, Missouri 1996-2002
White**
129.8
131.0
129.5
129.6
128.5
126.3
125.3
1996
2002
year
Year
1996
1997
1998
1999
2000
2001
2002
rate per 100,000
•Black women with breast cancer are less likely than white
women to survive 5 years.
138
rates per 100,000
Age-adjusted Female Breast Cancer Mortality
Rates, Missouri 1996-2002*
Black
127.5
116.4
122.1
125.3
120.5
118.4
111.0
* Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population.
** Incidence rates for white female breast cancer show a statistically significant decrease in
the time period 1996-2001.
Percentage of Early-stage§ Diagnosis for Female Breast
Cancer, Missouri 1996-2002
Year
White
Black
1996
65.3%
54.6%
1997
65.2%
59.5%
1998
68.6%
62.3%
1999
66.7%
60.3%
2000
68.2%
57.8%
2001
68.1%
59.8%
2002
66.8%
62.2%
§ Early-stage diagnosis includes In situ and Localized stages.
This project was supported in part by a cooperative agreement between
the Centers for Disease Control and Prevention (CDC) and the Missouri
Department of Health and Senior Services (DHSS) (#U55/CCU721904-04)
and a Surveillance Contract between DHSS and the University of Missouri.
•We examined trends for breast cancer incidence, stage at
diagnosis and mortality by race for 1996 – 2002.
•We also examined prevalence of mammography screening using
Behavioral Risk Factor Surveillance System (BRFSS) data for
1996-2000 and 2002.
Results:
•Incidence rates for white women decreased significantly from
1996 to 2002.
•Incidence rates for black women declined slightly from 1996 to
2002.
•Percentage of early-stage diagnosis was slightly higher for white
women than black women throughout the period.
•Mortality rates for black and white women were relatively stable
throughout the period.
Mortality Rates for Female Breast Cancer, Missouri 1996-2002*
Year
1996
1997
White
27.6
26.7
Black
41.0
36.4
1998
1999
2000
2001
2002
27.3
24.6
26.9
26.6
24.8
37.8
37.0
32.6
34.3
37.7
* Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population.
Weighted Responses to BRFSS Questions, Missouri 1996-2002+
Have you ever had a mammogram?^
•Mortality rates for black women were significantly higher than
for white women throughout the period.
•There were no differences by race in the percentage of women
who reported ever having had a mammogram.
Conclusion:
.
Recommendations:
•Efforts to increase screening, including targeting low-income,
underserved and uninsured women, should continue.
Black
Yes
60.8%
60.1%
No
39.2%
39.9%
Have you had a mammogram in the past two
years?^^
White
Black
•Black women were more likely to report having had a
mammogram in the past two years than white women.
•Efforts to reduce breast cancer incidence and mortality and
effectiveness of screening policies cannot be evaluated adequately
using only statewide data.
White
Yes
80.4%
88.0%
No
19.6%
12.0%
+ Responses
not available for 2001 as questions were not asked that year.
^ Denominator is all women 18 years of age and older.
^^ Denominator is all women who responded “yes” to first question.
Data Source:
MICA (Missouri Information for Community Assessment)
http://www.dhss.mo.gov/mica