Spatial variation and disparity in female breast cancer relative survival in the United States. Issue 21 (15th July 2021)

• Record Type: Journal Article
• Authors: Fan, Qinjin; Yao, Xiaobai A.; Han, Xuesong
• Is Part Of: Cancer. Volume 127:Issue 21(2021)
• Page Start: 4006
• Page End: 4014
• Publication Date: 2021-07-15
• Subjects: breast cancer -- disparity -- hotspot analysis -- relative survival -- spatial variation; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33801
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Breast cancer is the most common cancer among women in the United States. However, data on spatial disparities in survival for breast cancer are limited in the country. This study estimated 5‐year relative survival (RS) of female breast cancer and examined the spatial variations across the contiguous United States. Methods: Women newly diagnosed with breast cancer in 2003‐2010 in the United States were identified from the National Cancer Database and followed up through 2016. The crude 5‐year RS at the county level was estimated and adjusted for patients' key sociodemographic and clinical factors. To account for spatial effects, the RS estimates were smoothed using the Bayesian spatial survival model. A local spatial autocorrelation analysis with the Getis‐Ord Gi* statistics was applied to identify geographic clusters of low or high RS. Results: Clusters of low RS were identified in more than 15 states covering 671 counties, mostly in the southeast and southwest regions, including Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Approximately 30% of these clusters can be explained by patients' characteristics: Race, insurance, and stage at diagnosis appeared to be the major attributable factors. Conclusions: Significant spatial disparity in female breast cancer survival was found, with low RS clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Policies and interventions that focus on serving Black women, improvements in insurance coverage, and early detection in these areas could potentially mitigate the spatial disparities. Abstract : A significant spatial disparity in female breast cancer survival was found, with low relative survival clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. The findings highlight the promise of policies and interventions focusing on Black women, improving health insurance status, and early detection to mitigate spatial disparities in breast cancer survival.