This is the first to use enhanced registry data, accurately portraying the breast cancer burden. In the model only adjusted for age, Filipina women had worse survival than white women, a surprising finding since Asian women are characterized by relatively high survival [ 1 ], as seen in our non-Filipina other Asian group. Overall 5-year breast cancer survival in Nevada was Black and Filipina women had a higher risk of death than white women.
Black women, much less likely to get treatment according to standard care guidelines, have a lower likelihood of mastectomy [ 20 ], radiation after surgery [ 2122 ], and hormone therapy among those eligible [ 19 ]. Unique in its demographic features, Nevada is the seventh largest US state in terms of square miles [ 3 ], but has only two major metropolitan centers and is otherwise sparsely populated in its rural and frontier areas [ 10 ].
This shortage of physicians is likely a contributing factor to the survival disadvantage seen for patients in Southern Nevada. Data not shown. Patients diagnosed at autopsy only or by death certificate were dating filipina in Nevada, as well as cases with a negative or missing survival period. Some research has shown that access to primary care better predicts late stage at diagnosis than mammography rates [ 1333 ]. Our fully adjusted Cox models showed a persistent breast cancer survival disadvantage for black women in Nevada.
Additionally, as seen in other studies, our study showed that black women were diagnosed at later stages, but that controlling for tumor factors only attenuated without eliminating the survival disadvantage [ 1116 ]. While Southern Nevada does have one large teaching hospital, the state overall ranks 46 th in residency and fellowship programs, partially due to having just one public medical school, located in Northwestern Nevada [ 34 ].
A few other studies, mostly conducted in California where detailed demographic data on Asian subpopulations is collected, have looked at survival by Asian subgroup, and found that Filipina women had the worst breast cancer survival among Asians [ 2627 ].
Nevada regions were broken into three distinct : Southern, which includes 2. Studies have shown ificant overdiagnosis of early stage breast cancer, and only minimal decreases in late-stage diagnoses [ 31 ]. However, within Nevada, these shortages are primarily seen in the South [ 34 ].
The strongest predictor of breast cancer survival in Nevada women was stage at diagnosis, which has been linked to mammography screening [ 29 ]. Adjusted hazard ratios were computed with Cox proportional hazards regression.
Higher proportions of late stages of diagnosis among Filipinas ed for their relative survival disadvantage in Nevada. After adjusting for social factors, the Filipina survival disadvantage was somewhat attenuated. While historically white women have had the highest breast cancer incidence, as ofrates of black and white women have converged [ 2 ]. After fully adjusting for all covariates, only black women retained a ificantly higher risk than white women. ER-positive tumors are slower growing, less aggressive, and receptive to hormonal therapies, including dating filipina in Nevada, aromatase inhibitors, luteinizing hormone-releasing hormones, and fulvestrant [ 1 ].
Unfortunately, Nevada also ranks poorly in per population general and family practice physician rates, 22 perin compared to the US average of 31 per[ 34 ]. This study partially addresses those limitations by using enhanced Nevada Cancer Registry data to present age-adjusted 5-year survival for breast cancer. Yet, controversy exists regarding mammography. studies have demonstrated a breast cancer survival disadvantage for black women, with many factors converging to partially explain the disparity [ 11 ]. Our may suffer from a degree of residual confounding.
Cause-specific survival time was measured in months from the date of diagnosis until the date of death or, if not found as deceased, the date of last mortality linkage as of Dec 31,whichever occurred first.
Zip codes were classified by proportion of persons living in poverty according to US Census Bureau data. Estimates for SES were based on ecological zip code data for the residence of each cancer patient. Univariate analyses to determine ificant prognostic factors were performed using the log-rank test. Overall 5-year survival from breast cancer for Nevada women is lower than the US average. The lifetime risk for an American woman of developing breast cancer is Tumor size, histological type, and estrogen receptor status are also ificant pathological factors in predicting survival [ 1 ].
Surveillance, Epidemiology and End SEER staging localized, regional, or distantestrogen-receptor ER status positive or negativeand tumor grade 1, 2 or 3 well, moderately, or poorly differentiated, respectivelywere analyzed for prognostic ificance.
Black women are more likely to have aggressive tumors, including the triple negative molecular subtype [ 211 — 15 ]. On the other hand, Filipinas are also more likely than other Asian groups to be obese [ 23 ], which is linked to lower breast cancer survival [ 25 ]. There were 11, cases of breast cancer identified from — in the Nevada Central Cancer Registry. Stage at diagnosis was the most influential risk factor.
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Poor survival in the populous Southern region, including the Greater Las Vegas Metropolitan area, almost entirely explains this geographic disparity between Nevada and the US, as survival in the Northwestern Reno-Sparks Metropolitan area and the US is not dissimilar.
Interestingly, black women have high rates of self-reported mammography nationally [ 30 ], and Filipinas have been found to have the highest mammography screening rates among Asians [ 23 ]. Another likely reason for the region of Southern Nevada driving the survival disadvantage dating filipina in Nevada in the state is the lack of a public medical school in Southern Nevada, which is the largest major metropolitan area in the US without one [ 37 ].
Two social factors were included in the study, insurance status and socioeconomic status SES. Insurance information was classified into four : Medicare, private insurance, Medicaid, and no insurance. Try out PMC Labs and tell us what you think. This accurate characterization of the determinants of breast cancer survival in Nevada women should help set priorities not only for future research but also for appropriate public health and clinical interventions. Other potentially contributing factors to explain the survival disparity between black and white women include differences in mammography screening [ 17 ], higher proportions of obesity [ 11 ], delays in treatment after diagnosis [ 1819 ], and differences in treatment received.
Hopefully, this will serve to bridge the survival disparity between Northwestern and Southern Nevada that is also seen with other cancers [ 6 ]. Patients diagnosed at distant stage had Negative estrogen receptor status also conferred a risk 1.
For censored observations, the pd alive assumption was used. The extent to which nation-wide improvements over time in breast cancer survival can be attributed to treatment improvements or increases in mammography is unclear [ 31 ]. On the other hand, the Filipina disparity seen in our study was attributable to stage at diagnosis. Breast cancer was the most common type of new cancer diagnosed in women in the United States US in It was the second most deadly cancer after lung, ing for an estimated 40, deaths [ 1 ]. Yet, Washoe County, comprising the largest proportion of the Dating filipina in Nevada population in our study, has a per capita MD rates similar to the US, at per[ 34 ].
Two recent cancer reports, Cancer in Nevada [ 6 ] and the Nevada State Cancer Plan — [ 7 ], both highlighted the need for improvement in the Nevada Cancer Surveillance system in order to better quantify outcomes, especially survival. Only a few studies have characterized any cancer outcomes in Nevada. Breast cancer is the second deadliest cancer for women in the demographically unique mountainous west state of Nevada.
This study adds to the growing dating filipina in Nevada of literature on breast cancer survival disparities for blacks, as well as Filipinas. The Mountain West state of Nevada, with a estimated population of 2. Few studies have examined breast cancer specifically in Nevada. Moreover, we present evidence of a ificant breast cancer survival disparity between two urban regions of the state, separated by over miles of desert terrain [ 10 ]. InSouthern Nevada had only medical doctors MD per , compared to the national average of per[ 34 ]. Lacking individual level data on obesity and on other comorbidities, we were unable to adjust for these in our study, which may have affected our final estimates.
Better breast cancer survival outcomes have been associated with hospitals that have research activity and teaching status [ 38 — 40 ]. However, similar to what was revealed by Cox model 3 in our study, Lin et al. This study aims to accurately characterize breast cancer survival among the diverse women of the flourishing Silver State. Fortunately, Southern Nevada will soon have its own medical school, attracting experts to the state, with all of the associated benefits, including enhanced research and clinical trial opportunities, grant funding, increases in residency and fellowship programs, and ultimately, an increase in physicians.
Nevada is in the lowest quartile for state mammography rates. Learn More.
However, since our outcome was cancer-specific survival and we adjusted for stage at diagnosis, the potential effect of these variables was reduced. Pathological factors, identified at stage of diagnosis, were also included in the study. We used the life table method adjusted for age, according to the International Cancer Survival Standard [ 9 ] to enable comparison between Nevada and the United States survival estimates, using — SEER data.
Nevada Central Cancer Registry NCCR data were obtained for women diagnosed with a first primary invasive breast cancer from the years — Breast cancer codes C For the first time in Nevada, we made dating filipina in Nevada with the National Death Index as well as the Social Security Administration Masterfile in order to get accurate survival data by minimizing the of missing deaths. Almost one-third of all cases occurred in women under age Table I. Overall five-year age-adjusted survival in Nevada was Within the state, survival in Northwestern Nevada In stage-specific survival by region, Southern Nevada had consistently lower survival than Northwestern Nevada, although only ificant at the localized stage where cases are most numerous Compared to the overall US, Southern Nevada had ificantly lower survival at all stages, localized, regional, and distant, while Northwestern Nevada did not differ ificantly at any stage Table III.
In a Cox model controlling only for age, black and Filipina women had ificantly higher risk of death than white women, hazard ratio HR 1. This was not unexpected; compared to the US average, Filipinos are better educated, more likely to work professional jobs, and have higher incomes [ 2324 ].