Breast cancer in the inner city: intensive efforts may be succeeding

Breast cancer is a significant problem in a 518 bed government supported university hospital in New Jersey's largest city. The following records were reviewed: tumor registry abstracts of the 367 analytic breast cancer patients admitted from 1/1/91 to 12/31/92; the 455 participants in the Breast Cancer Detection Awareness Program (BCDAP) from 1987 to 1992; and the 460 breast biopsies performed from 1990 to 1992. Breast cancer is less common at this inner city hospital than in the U.S. in general; the stage is more advanced at presentation than in the U.S. overall; and the overall survival is only 54% at five years. Approximately 40% of the patients were African-American women from the inner city. Their median age was 53, seven years younger than the median age for diagnosis in the U.S. overall, and their five year survival was only 46%. Intensive efforts have recently produced improvement in the proportion of cases diagnosed at early stages (T0 and T1), but a decrease in mortality has not yet been seen.