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. 2017 Oct;27(10):654-658.
doi: 10.1016/j.annepidem.2017.09.002. Epub 2017 Sep 20.

Absence of an anticipated racial disparity in interval breast cancer within a large health care organization

Garth H Rauscher  1 , Firas Dabbous  2 , Therese A Dolecek  3 , Sarah M Friedewald  4 , Katherine Tossas-Milligan  3 , Teresita Macarol  5 , W Thomas Summerfelt  6
Affiliations

Absence of an anticipated racial disparity in interval breast cancer within a large health care organization

Garth H Rauscher et al. Ann Epidemiol. 2017 Oct.

Abstract

Purpose: Compared to non-Latina (nL) white women, nL black women are diagnosed with more aggressive breast cancers, which in turn should be more likely to go undetected on screening mammography and subsequently arise as interval breast cancer (IBC). We sought to estimate the extent of an anticipated racial disparity in IBC within a single, large health care organization.

Methods: The present analysis focuses on 4357 breast cancers diagnosed between 2001 and 2012 and within 18 months of a screening mammogram (N = 714,218). We used logistic regression with model-based standardization (predictive margins) to estimate adjusted prevalence differences corresponding to a racial disparity in IBC.

Results: Overall, prevalence of IBC within 18 months was 20.7%. Contrary to expectation, in patient-adjusted models, there was no IBC racial disparity (percentage point disparity = -2.1, 95% confidence interval: -4.7, 2.6). However, when controlling for facility characteristics, including proportion of nL black patients, the model coefficient for the IBC disparity reversed sign and changed substantially (P < .0001) and a racial disparity emerged (percentage point disparity = +5.1, 95% confidence interval: -0.3, 9.9).

Conclusions: The sorting of patients by race across facilities appears to have mitigated an otherwise anticipated disparity in IBC. Possible explanations are discussed.

Keywords: African Americans; Breast neoplasms; Caucasian race; Mammography.

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Conflict of interest statement

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    All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version.

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    This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue.

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    The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript

Figures

FIGURE 1
FIGURE 1
All data are aggregated at the facility and calendar year level (one observation for wach combination of facility and calendar year). Panel A: Boxplot comparing false positive rates for nL WhIte and nL Black patients. Panel B: Scatter plot where each dot represents a aggregate data for cancer detection rate and false positive rate for a specific facility and calendar year, along with a best fitting linear projection from a regression of cancer detection rate regressed on false positive rate. Panel C: Scatter plot where each dot represents a aggregate data for interval breast cancer prevalence and cancer detection rate for a specific facility and calendar year, along with a best fitting linear projection from a regression of interval breast cancer prevalence regressed on cancer detection rate.
See this image and copyright information in PMC

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