Geographic Variation in Breast Cancer Stage at Diagnosis
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Breast cancer stage at diagnosis (BCSAD) is generally reported in 3 progressive stages: 1) localized tumors are malignant and invasive but confined to the organ of origin; 2) regional neoplasms have extended beyond the organ of origin into surrounding tissues, involve regional lymph nodes, or both; and 3) distant tumors have spread to remote parts of the body from the primary site. An earlier, more localized BCSAD is highly desirable because it is directly related to survival and mortality. But previous research has shown that the percentages of breast cancer patients with a localized tumor at diagnosis ranged from 40% to 71% in California counties. The individual-level patient characteristics (e.g., age, race-ethnicity, health insurance status) associated with BCSAD have been investigated. This pioneering research will focus on the community-level factors (health policy and financing, health care delivery system, and community risk factors) associated with better or worse BCSAD that have not been investigated previously. 
 
 
 
 
 
 
 
 
 
 Data obtained from this study will be used to address two central research questions: 1) How do county level differences in health policy and financing, local health care delivery systems, and community risk factors influence BCSAD? and 2) What are the implications for developing effective community-level policies, programs, and health services to improve this cancer outcome? 
 
 
 
 
 
 
 
 
 
 The general methodology in non-technical terms: The research team will obtain county-level data from multiple data sources including: 1) Information on female breast cancer patients obtained from the California Cancer Registry; 2) A variety of other data sources to obtain information on health policy and financing, health care delivery system, and community risk factors; and 3) Information obtained from the California Health Interview Survey (CEIIS), focusing on access to health insurance and health care including cancer related questions developed by the National Cancer Institute. Data will be analyzed to compare county-level differences in BCSAD and the individual- and community-level determinants. Two members of the project Advisory Board are founders of community-based organizations providing breast cancer consumer education and advocacy programs. Advisory Board members will provide on-going consultation and advice regarding implications for supporting breast cancer patients and reducing the impact of breast cancer in California. 
 
 
 
 
 
 
 
 
 
 No studies in cancer health services research have investigated the effects of community-level determinants of cancer outcomes in a comprehensive way. However, as information systems and data analysis methods become more sophisticated, researchers are beginning to develop the capacity to obtain and analyze data from a variety of data sources, enabling a more comprehensive analysis of both patient and community characteristics influencing BCSAD. Ultimately, state and local policymakers and health services leaders should have the data to: 1) develop a better understanding of the community risk factors and resources unique to their geographic area; 2) become more aware of effective community-level interventions leading to better cancer prevention and control; and 3) have a data driven rationale for allocating resources to improve policies, programs, and health services.