A feasibility study of the evaluation of the Florida breast cancer early detection program using the statewide cancer registry

Abstract

In Florida, a Center for Disease Control and Prevention (CDC)-funded initiative of the Florida Department of Health has targeted socio-economically disadvantaged women for breast and cervical cancer screening. Since 1995, over 12,000 women aged 50-64, within 200% of the federally defined poverty level, with no health insurance, and living in metropolitan catchment areas in Florida, have been screened by the Florida Breast and Cervical Cancer Early Detection Program (BCCEDP). This was a matched cohort cross-sectional analysis of a cohort study of Florida women with breast cancer using the Florida incident cancer registry, the Florida Cancer Data System (FCDS). The study evaluated the hypothesis that there would be no difference in the stage at diagnosis between breast cancer cases in the BCCEDP-screening program and breast cancer cases not diagnosed in the screening program. After linking the BCCEDP records with the FCDS, BCCEDP-screened cases were matched on gender, age, race, ethnicity, and other variables with five groups of FCDS breast cancer cases not screened by BCCEDP to control for demographic and socio-economic factors. Breast cancer cases diagnosed in BCCEDP were significantly more likely to be diagnosed at later stage than non-BCCEDP breast cancer cases in the five matched groups. The BCCEDP is not purely a screening program since it also caters to symptomatic women in the indigent population, therefore these finding were expected. In fact, 71% of the BCCEDP cases were symptomatic at the time of screening/diagnosis and 53% were late-stage diagnosed. These findings show that BCCEDP is indeed servicing its targeted population of medically under-served and symptomatic women in Florida. Furthermore, despite limitations, this study illustrates the potential collaboration between cancer registries and breast cancer screening programs for quality control purposes.