Geographical influence on racial disparity in breast cancer presentation in the United States

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It has been shown that breast cancer presentation varies between racial groups nationwide. Several studies have suggested that this is more a function of geographic rather than true racial disparity. The current study was undertaken to examine racial disparity in breast cancer presentation and to determine whether such disparity continues to be seen once geographic factors are taken into account. Breast cancer data were reviewed for all programs reporting to the American College of Surgeons Commission on Cancer National Cancer Database (NCDB) between 2000 and 2007, inclusive. These data were readily available online. Variables reviewed were: stage at the time of presentation; race; histology; and geographic location within the United States. Four broad regions of the country were chosen, corresponding to the U.S. Census Regions: Northeast, South, Midwest, and West. Patient data were classified as either "early" (stages 0, I, and II) or "late" (stages III and IV) at the time of presentation. A total of 1,388,186 patients were reported during the study period; 1,132,128 white and 256,058 nonwhite. There was a statistically significant difference in presentation between the two racial cohorts; a significantly higher percentage of whites presented with "early" disease (88.8%) when compared with nonwhites (83.8%). This statistically significant difference persisted even when the data were corrected for geographic location within the United States. There is a racial disparity with regard to breast cancer presentation throughout the United States which seems to be independent of geographic location. Nonwhites in all geographic regions present with later-stage disease than whites.