Purpose

Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations.

Methods

This analysis included 2,058 women age 45–74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to “During the past ten years, who did you usually see when you were sick or needed advice about your health?”) were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified.

Results

Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8–13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2–6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76–3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15–4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina.

Conclusions

Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.

中文翻译：

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了解乳腺癌种族差异的机制：卡罗莱纳州乳腺癌研究中筛查和定期护理的评估

目的

筛查史影响检测阶段，但定期预防护理也可能影响乳腺肿瘤的诊断特征。很少有研究评估不同种族的符合筛查资格的人群中的医疗保健利用率（筛查和初级保健）。

方法

这项分析包括来自卡罗莱纳州乳腺癌研究的 2,058 名 45-74 岁女性（49% 黑人），该研究是一个基于人口的队列，由 2008 年至 2013 年间被诊断患有浸润性乳腺癌的女性组成。筛查历史（阈值每年 0.5 次乳房 X 光检查）和预筛查诊断医疗保健利用（即定期护理，基于对“过去十年中，当您生病或需要有关健康的建议时通常去看谁？”的回答）被评估为二元暴露。对医疗保健利用率和肿瘤特征之间的关系进行了总体评估和种族分层。

结果

在那些缺乏筛查的人中，黑人参与者的肿瘤较大 (5 + cm)（频率 19.6% vs 11.5%，相对频率差 (RFD) = 8.1%，95% CI 2.8–13.5），但坚持筛查的种族差异减弱参与者（10.2% vs 7.0%，RFD = 3.2%，0.2–6.2）。肿瘤分期和检测模式（乳房X光检查与肿块）也观察到类似的趋势。在所有参与者中，缺乏筛查和定期护理的患者肿瘤较大（21% vs 8%，RR = 2.51, 1.76–3.56）和晚期 (3B +) 阶段（19% vs 6%，RR = 3.15, 2.15–4.63 ）与参考类别（坚持筛查和定期护理）相比。在北卡罗来纳州社会经济弱势地区，定期护理和筛查的利用不足更为普遍。

结论

获得定期护理是早期发现的重要保障。我们的数据表明，健康公平干预措施应优先考虑初级保健和筛查。