Abstract 3585: Persistent poverty and late-stage breast cancer diagnosis in the United States: Impacts of rurality, race, and time within Surveillance, Epidemiology, and End Results (SEER) registries, 2004 to 2021
Authors: Heather R. Sherr, Amr Soliman, Kimberly A. Bertrand, Kelly A. Hirko
Journal: Cancer Research (2025)

Abstract Background: County-level poverty is associated with late-stage breast cancer (BC) diagnosis, though the effects of persistent poverty (&amp;gt;20% residents in poverty for 30+ years) are unclear. Persistent poverty’s role may also vary by rurality, race, and over time. Methods: We analyzed county-level data from the Surveillance, Epidemiology, and End Results (SEER) Program for females (ages 20-74 years) diagnosed with late-stage (regional and distant) BC from 2017-2021 (excluding 2020). We estimated mean rate differences (RDs) in late-stage BC between persistently poor (n = 156) and non-persistently poor (n = 923) counties using multivariable linear regression. Models were adjusted for age, current poverty, race, lack of insurance, unemployment, and educational attainment using data from the American Community Survey (ACS) between 2017 and 2021. We stratified results by rurality (rural vs. urban based on Rural-Urban Continuum Codes) and race (≥ 5% vs. &amp;lt; 5% Non-Hispanic Black). Joinpoint regression was used to estimate annual percent change (APC) in BC stage at diagnosis rates from 2004-2019 according to persistent poverty status and rurality. Results: Age-adjusted late-stage BC rates were higher in persistent poverty compared to non-persistent poverty counties (RD = 5.78 per 100, 000 person-years, 95% CI = 2.46, 9.10). Differences in late-stage BC rates by persistent poverty status were similar in rural and urban counties but elevated in counties with larger non-Hispanic Black populations. Associations were attenuated in adjusted models (overall RD = 3.22, 95% CI = -1.13, 7.56). However, fully adjusted late-stage BC diagnosis rates were higher in persistently poor counties with small non-Hispanic Black populations (RD = 8.32, 95% CI = 1.39, 15.26). Overall rates of breast cancer diagnosed at the distant stage increased from 2004 to 2010 (APC = 2.01, 95% CI = 1.09, 4.87) and have remained constant since (APC = 0.04, 95% CI = -1.65, 0.52). The rise in distant BC was driven by counties characterized by persistent poverty (APC = 1.79, 95% CI = 0.95, 2.62) and rurality (APC = 1.78, 95% CI = 0.68, 2.87). Regional breast cancer rates declined from 2004-2017 (APC = -1.05, 95% CI = -2.04, -0.74), but have been rising since (APC = 1.57, 95% CI = -0.93, 3.02). Conclusions and Implications: Late-stage BC diagnosis rates were elevated in persistent poverty counties, but the difference was reduced after adjusting for current poverty. Rates of distant BC have risen over time, particularly in persistent poverty and rural counties. Efforts to alleviate the burden of poverty and address barriers to screening are needed to promote early BC detection, particularly in medically underserved areas. Citation Format: Heather R. Sherr, Amr Soliman, Kimberly A. Bertrand, Kelly A. Hirko. Persistent poverty and late-stage breast cancer diagnosis in the United States: Impacts of rurality, race, and time within Surveillance, Epidemiology, and End Results (SEER) registries, 2004 to 2021 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3585.