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

作者：Rauscher Garth H^*; Dabbous Firas; Dolecek Therese A; Friedewald Sarah M; Tossas Milligan Katherine; Macarol Teresita; Summerfelt W Thomas

来源：Annals of Epidemiology, 2017, 27(10): 654-658.

DOI：10.1016/j.annepidem.2017.09.002

• Breast neoplasms
• African Americans
• Caucasian race
• Mammography

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.

• 出版日期2017-10
• 单位西北大学