Using Data to Reduce Breast Cancer Disparities
Louisiana Tumor Registry
Studies show that women of lower socioeconomic status (SES) and the medically underserved often are diagnosed with advanced stages of cancer compared with women of higher SES or who have a usual source of care. Data from the Louisiana Tumor Registry (LTR) confirmed that a higher proportion of breast cancer patients diagnosed at the Louisiana public hospital system had advanced-stage (regional and distant) tumors than patients diagnosed in other facilities (40% vs. 31% for whites, and 49% vs. 41% for African Americans).
To address this disparity, a screening mammography program was implemented in 2001 at the public hospitals that serve primarily indigent and uninsured patients. Distribution of stage at diagnosis was examined to assess the effectiveness of the breast cancer early detection initiative. Because the LTR has more accurate and complete staging information, we collaborated with public hospital researchers by linking registry data with those from the public hospital system to enhance the richness of combined data set.
Analysis of stage data by patient type revealed interesting findings. Patients who received health care in the six-month period before they were diagnosed with breast cancer, called "sustained" patients, had a higher proportion of early-stage tumors (61%) than "fly-in" patients who did not visit a clinic in the six-month period before they were diagnosed with breast cancer (47%). During the six-year program period, sustained patients had a slight improvement in early-stage diagnosis (from 63% to 68%), but the proportion of early-stage tumors stayed nearly the same for fly-in patients (from 49% to 48%).
The LTR's participation in this initiative illustrates the importance of collaboration with other public health partners and innovative use of cancer registry data in identifying the hard-to-reach target population for cancer control programs.