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Carcinoma detection at the breast examination center of Harlem
Laura Liberman1, Harold P Freeman, Sukanya Chandra
1Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. libermal@mskcc.org
Insights
A breast carcinoma screening program in Harlem detected early-stage cancers in an underserved population. Outreach is crucial, especially for uninsured women, to improve breast cancer outcomes.
Area of Science:
- Oncology
- Public Health
- Radiology
Background:
- Breast carcinoma is a leading cause of mortality in Harlem, NYC, a community with significant health disparities.
- This study evaluated a breast carcinoma screening and diagnostic program implemented in Harlem.
Purpose of the Study:
- To assess the effectiveness of a breast carcinoma screening and diagnostic program in an underserved urban population.
- To identify characteristics of breast carcinomas detected and treatment outcomes.
Main Methods:
- Retrospective review of 49,750 visits to the Breast Examination Center of Harlem (1995-2000).
- Analysis of medical records for 178 women diagnosed with 181 breast carcinomas, focusing on detection method, stage, and treatment.
- Statistical comparison of palpable versus nonpalpable breast carcinomas.
Main Results:
- The study population was predominantly Black or Hispanic (89%), uninsured (45%), and low-income (38%).
- A significant proportion of detected breast carcinomas were early-stage (Stage 0 or I: 46%) or minimal (34%).
- Nonpalpable breast carcinomas, detected by mammography, were more likely to be ductal carcinoma in situ or minimal and treated with breast-conserving surgery.
Conclusions:
- The breast carcinoma screening program successfully identified early-stage, curable cancers in a vulnerable population.
- Outreach efforts are essential to reach underserved individuals, particularly the uninsured, for timely diagnosis and treatment.
- The findings highlight the importance of targeted screening programs in reducing breast carcinoma disparities.
Background:
Breast carcinoma is one of the leading causes of excess mortality rates in Harlem, an inner-city neighborhood with the highest mortality rates and worst life expectancy in New York City. This study reports the results of a breast carcinoma screening and diagnostic program in Harlem.
Methods:
Retrospective review was performed of a database of 49,750 visits to the Breast Examination Center of Harlem from 1995 to 2000. During this period, 181 breast carcinomas were diagnosed in 178 women. The medical records of these 178 women were reviewed to determine the method of detection, stage, and treatment.
Results:
Among these women, 89% were black or Hispanic, 45% had no medical insurance, and 38% had incomes below federal poverty guidelines. Breast carcinoma stage, known for 167 carcinomas, was Stage 0 in 38 (23%), Stage I in 38 (23%), Stage II in 63 (38%), Stage III in 24 (14%), and Stage IV in 4 (2%). Fifty-six cases (34%) were minimal breast carcinomas. Of 181 breast carcinomas, 122 (67%) were palpable and 59 (33%) were nonpalpable, detected only by mammography in asymptomatic women. Nonpalpable, as opposed to palpable, breast carcinomas were significantly more likely to be ductal carcinoma in situ (30 of 55 [54%] vs. 8 of 112 [7%], P < 0.0000001) or minimal breast carcinoma (39 of 55 [71%] vs. 17 of 112 [15%], P = 0.0000001) and were more likely to be treated with breast-conserving surgery (47 of 56 [84%] vs. 76 of 110 [69%], P < 0.04).
Conclusions:
A breast carcinoma screening and diagnostic program has been established in Harlem, a traditionally underserved area in New York City. Early, curable breast carcinomas were detected but outreach remains a challenge, particularly for the uninsured.