Abstract
BACKGROUND: This study assessed the relationship between area-level poverty and stage of breast cancer at diagnosis among low-income women when screening mammography was available at no cost. METHODS: The authors identified women diagnosed with breast cancer from 1999 to 2005 through the Massachusetts Cancer Registry, and compared the odds of advanced stage disease for women with low incomes (n=546) for whom screening mammography and diagnostic services were available at no cost through the Massachusetts Breast and Cervical Cancer Early Detection Program, relative to a nonparticipating comparison group (n=1287) residing in the same neighborhoods with similar distribution of age, race, and ethnicity as Massachusetts Breast and Cervical Cancer Early Detection Program participants. Among Massachusetts Breast and Cervical Cancer Early Detection Program participants, the odds of advanced stage disease were estimated by mammography use. RESULTS: Although screening mammography was available at no cost, only 36% of program participants diagnosed with breast cancer used screening mammography. Stage of breast cancer at diagnosis was not associated with area-level poverty among Massachusetts Breast and Cervical Cancer Early Detection Program participants. For the comparison group, advanced stage disease was more likely for residents in high-poverty areas, relative to low-poverty areas (49% vs 37%, P<.01). The adjusted odds of advanced stage disease at diagnosis was greater for women aged 41 to 49 years, compared with those aged 50 to 64 years (P=.01). CONCLUSIONS: Programs that ensure breast cancer screening and diagnostic services are available at no cost to low-income women can mitigate the adverse effect of area-level poverty on stage of breast cancer. However, such programs require effective strategies to encourage use of screening mammography to promote diagnosis at an earlier stage.