Breast cancer: a socioeconomic and racial comparison in northwest Louisiana

A tumor registry data review on breast cancer populations seen at two hospitals in North Louisiana was completed in order to determine if race is independent of socioeconomic status (SES) factors related to breast cancer stage at diagnosis. The North Louisiana tumor registry identified 1183 patients diagnosed with breast cancer between 1987 and 1991, 304 patients from Louisiana State University Health Science Center (LSUHSC), a state supported hospital providing predominantly indigent care, and 879 patients from a private hospital (PH) serving predominantly insured patients. Hospital site was used as a proxy for SES (LSUHSC low, PH high). The patient populations differed significantly by age, racial makeup, and stage at presentation. Both white and African-American patients seen at PH had more stage 0 disease compared with LSUHSC (9.2% and 2.7%). White patients seen at PH had more stage I cancer as compared to white patients at LSUHSC (31.3% and 19.2%) or African-American patients at either PH or LSUHSC (19.4% and 19.9%). The frequency of stage III/IV cancer was higher in African-American patients at both LSUHSC (30.1%) and PH (29.0%) and white patients at LSUHSC (24.0%) as compared to white patients at PH (14.7%). Two hundred and nine patients were available for individual interview and specific definition of SES. LSUHSC patients were predominantly indigent (83% indigent and without insurance), while only 10% of PH patients lacked insurance. This study provides further support that the SES of white patients influences breast cancer stage at presentation. African-American patients, however, presented with more advanced breast cancer stages regardless of SES. Factors influencing African-American patient's disease stage are not limited to defined SES factors. Further studies are needed to define barriers and develop intervention strategies.