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Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17% respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study. KEYWORDS breast cancer; early detection, cancer disparities, mammography DOI: 10.1080/03630242.2010.530928

Breast cancer is the most frequently occurring malignancy among women in India, however, the recorded stage distribution at presentation in India is less favorable than in Europe. Health beliefs are important in help-seeking for potential symptoms of disease, which may be particularly important among women who do not have access to breast screening programs. The purpose of this study was to examine Indian women's beliefs about breast cancer and help-seeking for the disease and how these beliefs related to their intentions to seek help for a symptom of breast cancer. Furthermore, the study aimed to examine differences in the beliefs of urban- and rural-based women. Of 800 women, 685 were recruited in Allahabad in Northern India (response rate 86%). The women completed a questionnaire examining beliefs about breast cancer and help-seeking. One in four women reported that they would delay seeking help for at least one month following the discovery of a symptom of breast cancer. Rural respondents held more negative beliefs about breast cancer and were also more likely to report less positive attitudes toward help-seeking and a belief that they would be discouraged from seeking help. The findings of the study provide suggestions for the targeting of an intervention aimed at improving early detection and help-seeking for breast cancer symptoms. This may be of particular importance in India where a breast cancer screening program does not currently exist and is being debated. KEYWORDS breast cancer, help-seeking, illness beliefs, theory of planned behavior DOI: 10.1080/03630242.2010.498752

Objective: To compare breast cancer incidence in England and Australia by age, extent of disease and deprivation. Methods: We analysed data for women aged 15-99 years diagnosed with breast cancer in England or Australia during the period 1990 to 1994, and in West Midlands or New South Wales during the period 1980 to 2002. We calculated three-year rolling average incidence rates and incidence rate ratios (IRR) between West Midlands and New South Wales by age, extent of disease and category of deprivation. Results: Breast cancer incidence was higher in England than in Australia, and in West Midlands than in New South Wales but became more similar over time. Socioeconomic differences in incidence were greater in New South Wales than in West Midlands. The most deprived women in West Midlands were diagnosed at a later stage of disease than the most deprived women in New South Wales. Incidence among elderly women was higher in West Midlands than in New South Wales. There were also high proportions of tumours with unknown stage among elderly women in West Midlands. Conclusions: Although the overall incidence of breast cancer is similar, differences by age, extent of disease and deprivation exist. Implications: The underlying reasons for these patterns require further examination. Key words: breast cancer, incidence, Australia, England, women. Aust NZ J Public Health. 2010; 34:206-13 doi: 10.1111/j.1753-6405.2010.00508.x

Objective: To estimate the association between measures of socio-economic status (SES) and breast cancer (BC) survival for young, urban Australian women. Methods: We used a population-based sample of 1,029 women followed prospectively for a median of 7.9 years. SES was defined by education and area of residence. Hazard ratios (HRs) associated with SES measures were estimated for (i) distant recurrence (DR) and (ii) all-cause mortality as end-points. Results: HRs for area of residence were not significantly different from unity, with or without adjustment for age at diagnosis and education level. The univariable HR estimate of DR for women with university education compared with women with incomplete high school education was 1.51 (95% CI = 1.08 - 2.13, p = 0.02), which reduced to 1.20 (95% CI = 0.85 - 1.72, p = 0.3) after adjusting for age at diagnosis and area of residence. Adjusting for prognostic factors differentially distributed across SES groups did not substantially alter the association between survival and SES. Conclusions: Among young, urban Australian women there is no association between SES and BC survival. Implications: This lack of estimates of association may be partly attributed to universal access to adequate breast cancer care in urban areas. Key words: Breast cancer, socioeconomic status, Australia, survival. Aust NZ J Public Health. 2010; 34:200-5 doi: 10.1111/j.1753-6405.2010.00507.x

Objectives. We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age. Methods. To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses. Results. Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI = 1.20, 1.44), but similar between US- and foreign-born Japanese women. US born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000-2004, the rate among US-born Filipina women exceeded that of White women. Conclusions. These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors. (Am J Public Health. 2010;100:S125-S131. doi: 10.2105/AJPH. 2009.163931)

Breast cancer is the second leading cause of cancer death among African American women and the leading cause of cancer death among women 40 to 55 years of age (American […]

Byline: D. A. Nelson (1,3,4), L. L. Darga (1,3), M. S. Simon (1,3), R. K. Severson (2,3) Keywords: Bone density; Breast cancer risk; Ethnicity Abstract: A number of different models for assessing individual risk of breast cancer use known risk factors such as age, age at menarche, age at first live birth, previous breast biopsies, and family history. High bone mass in white women is also associated with an increased breast cancer risk however, bone mass as a risk factor has not been studied in African-American women. We conducted a case-control study to evaluate bone mineral density as a risk factor for breast cancer in white and African-American women. We recruited 221 women with newly diagnosed breast cancer from a comprehensive breast cancer center at a large university hospital, and 197 control women who were frequency matched for ethnicity and age. Odds ratios were based on proximal and distal radial bone density measured by peripheral bone densitometry (Norland pDEXA) and expressed as a standardized 'Z-score' (age and ethnicity specific). Logistic regression models were fitted controlling for body mass index, menopausal status, age, and HRT use (ever/never and duration). With proximal bone density Z-score included in the model as a continuous variable, a one-unit increase in radial shaft bone density increased the risk of breast cancer by 25% (p=0.02). When proximal bone density Z-score was analyzed as a dichotomous variable (a$?0, &gt 0) the odds ratio was 1.98 (95% CI, 1.32 to 2.97) that is, having an above average proximal bone density (age-specific) doubles the risk of breast cancer. There were no significant interactions with, and no appreciable confounding effects by, other covariates. An above-average radial shaft Z-score is a significant risk factor for breast cancer in both white and African-American women. The present study extends the association between bone mass and breast cancer risk to African-Americans, and suggests another potential application for bone density testing. Author Affiliation: (1) Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA (2) Department of Family Medicine, Wayne State University, Detroit, MI 48201, USA (3) Karmanos Cancer Institute, Detroit, MI 48201, USA (4) Rheumatology, UHC 4-H, Wayne State University, 4201 St Antoine Blvd, Detroit, MI 48201, USA Article History: Registration Date: 16/12/2003 Received Date: 11/07/2003 Accepted Date: 15/12/2003 Online Date: 04/02/2004

Background. Breast cancer care, such as utilization of screening procedures and types of treatment received, varies substantially by geographic region of the United States. However, little is known about variations in survival with breast cancer. Methods. We examined breast cancer incidence, survival, and mortality in the 66 health service areas covered by the Surveillance, Epidemiology, and End Results (SEER) program for women aged 65 and older at diagnosis. Incidence and survival data were derived from SEER, while breast cancer mortality data were from Vital Statistics data. Results. There was considerable variation in breast cancer survival among the 66 health service areas ([chi square] = 202.7, p < .0001). There was also significant variation in incidence and mortality from breast cancer. In a partial correlation weighted for the size of the health service area, both incidence (r = .812) and percent 5-year survival (r = -.587) correlate with mortality. In a Poisson regression analysis, the combination of variation in incidence and variation in survival explains 90.9% of the variation in mortality. Conclusions. There is considerable geographic variation in survival from breast cancer among older women, and this contributes to variation in breast cancer mortality. Geographic variations in breast cancer mortality should diminish as the quality of breast cancer care becomes more standardized.

Objectives. This study examined the association between a residential area's socioeconomic status (SES), race, and advanced-stage breast cancer in New York City. Methods. The cross-sectional study design used breast cancer information for 37 921 cases diagnosed in New York City from 1986 to 1995. Residential education and income levels were based on the 1990 census and ascribed to each case by zip code. Associations between race, area SES, and advanced-stage breast cancer stage, and the interaction between race and SES, were evaluated in bivariate and multivariate analyses. Results. After adjusting for age and year at diagnosis, living in areas with lower levels of education and income increased the odds of presenting with advanced-stage breast cancer by 50% for Black women and by 75% for White women. No significant qualitative interaction was present between area SES and race. Conclusions. This study confirmed independent racial and socioeconomic differences in the risk of advanced-stage breast cancer in a large and diverse population. The results emphasize the need to improve screening practices and clinical treatment in both high-risk populations and high-risk geographic areas.

Research indicates that family history is the strongest predictor of ovarian or breast cancer susceptibility. In studies on Ashkenazi Jewish women, those who reported family members who contracted the diseases before age 50 were likely to be carrying the BRCA1 and BRCA2 genes. Although this process provides accurate estimation, conclusive identification for single individuals remains elusive.

Research on the BRCA1 and BRCA2 genes has helped medical scientists target female populations susceptible to ovarian and breast cancer, but the data are unable to determine conclusively which individuals will actually develop cancer. This raises the ethical issue of whether it is psychologically helpful or harmful to provide this information to women within the risk demographic.