Incorporating Multiple Evidence Sources for the Assessment of

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Incorporating Multiple Evidence Sources for the Assessment of Breast Cancer Policies and Practices J.

Incorporating Multiple Evidence Sources for the Assessment of Breast Cancer Policies and Practices J. Jackson-Thompson, Gentry White, Missouri Cancer Registry, University of Missouri-Columbia; M. J. King, Missouri Department of Health and Senior Services Background: • Breast cancer accounts for c. 1/3 of cancers among U. S. women. • Early detection and timely, appropriate treatment increase 5 -year survival. • Black women with breast cancer are less likely than white women to survive 5 years. • Lack of health insurance and low income are other factors associated with lower survival. Purpose: • To evaluate efforts to reduce breast cancer incidence and mortality. • To examine effectiveness of screening policies and practices. Methods: Age-adjusted Incidence Rates* for Invasive Female Breast Cancer, Missouri 1996 -2002 Year 1996 1997 1998 1999 2000 2001 2002 White** 129. 8 131. 0 129. 5 129. 6 128. 5 126. 3 125. 3 Black 127. 5 116. 4 122. 1 125. 3 120. 5 118. 4 111. 0 * Rates are per 100, 000 persons and are age-adjusted to the 2000 U. S. standard population. ** Incidence rates for white female breast cancer show a statistically significant decrease in the time period 1996 -2001. Percentage of Early-stage§ Diagnosis for Female Breast Cancer, Missouri 1996 -2002 Year White Black 1996 65. 3% 54. 6% 1997 65. 2% 59. 5% 1998 68. 6% 62. 3% 1999 66. 7% 60. 3% 2000 68. 2% 57. 8% 2001 68. 1% 59. 8% 2002 66. 8% 62. 2% § Early-stage diagnosis includes In situ and Localized stages. This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS) (#U 55/CCU 721904 -04) and a Surveillance Contract between DHSS and the University of Missouri. • We examined trends for breast cancer incidence, stage at diagnosis and mortality by race for 1996 – 2002. • We also examined prevalence of mammography screening using Behavioral Risk Factor Surveillance System (BRFSS) data for 1996 -2000 and 2002. Results: • Incidence rates for white women decreased significantly from 1996 to 2002. • Incidence rates for black women declined slightly from 1996 to 2002. • Percentage of early-stage diagnosis was slightly higher for white women than black women throughout the period. • Mortality rates for black and white women were relatively stable throughout the period. Mortality Rates for Female Breast Cancer, Missouri 19962002* Year White Black 1996 27. 6 41. 0 1997 26. 7 36. 4 1998 1999 2000 2001 2002 Weighted Responses to BRFSS Questions, Missouri 1996 -2002+ Have you ever had a mammogram? ^ • There were no differences by race in the percentage of women who reported ever having had a mammogram. Conclusion: Recommendations: • Efforts to increase screening, including targeting low-income, underserved and uninsured women, should continue. White Black Yes 60. 8% 60. 1% No 39. 2% 39. 9% Have you had a mammogram in the past two years? ^^ White Black • Black women were more likely to report having had a mammogram in the past two years than white women. . 37. 8 37. 0 32. 6 34. 3 37. 7 * Rates are per 100, 000 persons and are age-adjusted to the 2000 U. S. standard population. • Mortality rates for black women were significantly higher than for white women throughout the period. • Efforts to reduce breast cancer incidence and mortality and effectiveness of screening policies cannot be evaluated adequately using only statewide data. 27. 3 24. 6 26. 9 26. 6 24. 8 Yes 80. 4% 88. 0% No 19. 6% 12. 0% + Responses not available for 2001 as questions were not asked that year. ^ Denominator is all women 18 years of age and older. ^^ Denominator is all women who responded “yes” to first question. Data Source: MICA (Missouri Information for Community Assessment) http: //www. dhss. mo. gov/mica