Associations Between Perceived Discrimination, Screening Mammography, and Breast Cancer Stage at Diagnosis: A Prospective Cohort Analysis.

Autor: Hernandez AE; Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA., Borowsky PA; Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA., Lubarsky M; University of Miami Miller School of Medicine, Miami, FL, USA.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA., Carroll C; University of Miami Miller School of Medicine, Miami, FL, USA.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA., Choi S; University of Miami Miller School of Medicine, Miami, FL, USA.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA., Kesmodel S; Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA., Antoni M; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.; Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA., Goel N; Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA. neha.goel@med.miami.edu.; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA. neha.goel@med.miami.edu.; Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA. neha.goel@med.miami.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Nov; Vol. 31 (12), pp. 8012-8020. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1245/s10434-024-15757-0
Abstrakt: Background: Despite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis.
Methods: A prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis.
Results: The study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01-1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92-0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust.
Discussion: This study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient-provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival.
(© 2024. The Author(s).)
Databáze: MEDLINE
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