Category Archives: Ecological Study

Delay in Breast Cancer Diagnosis and Increase in Mortality

In the United States, it is National Women’s Health Week. I am going to try to post about a different and key area of Women’s Health through this week.

Today, I am going to point you to the summary of some important results from a very interesting paper on breast cancer diagnosis delays. I only have the summary to offer as the paper itself sits behind a pay wall. Still, even the summary should give one pause and suggestions of key demographics to aim at, in trying to bring up the diagnosis.

Study Limitation

This study, like the one mentioned in yesterday’s blog is also an ecological study and therefore, does not have the strength and rigor of a prospective, clinical study. However, the study results are still very valuable and informative.

Summary of Key Findings (Quoted)

Delays in diagnosis could possibly affect survival as well. While it is possible to quote from the summary, the mdedge article that originally pointed me to the paper has a nice summary, and I am going to quote it here. The article itself is linked below:

  • Women who received Medicaid or were uninsured were more than twice as likely to be diagnosed at a later stage, vs those with commercial insurance.
  • Blacks were 18% more likely than whites to experience such.
  • Unmarried women were 25% more likely than their married counterparts to be diagnosed later.
  • Younger patients were 25% more likely than older individuals to experience delayed diagnosis.
  • Compared with commercially insured patients, death rates from breast cancer in Medicaid and uninsured women were 40% and ~60% higher, respectively.
  • This rate was nearly 40% higher in blacks vs whites, and nearly 20% higher in unmarried vs married women.

Conclusion

As you can see, social status, insurance, and even marital status as well as age make significant contributions to delay in diagnosis. Similar issues exist with survival and mortality. As the authors state in the study, it is important to explore these demographic and social status differences further. When separated by sex, Breast Cancer is the leading cause of cancer based mortality among women in the United States. Every effort must be made to ensure increased awareness, early diagnosis and treatment of breast cancer!

References: 

  1. Summary of the Study: http://onlinelibrary.wiley.com/doi/10.1002/cncr.30722/full
  2. The mdedge article: http://www.mdedge.com/oncologypractice/clinical-edge/summary/practice-management/these-factors-impact-breast-cancer?group_type=2-month&topic=278&utm_source=News_Power_eNL-B_051417&utm_medium=email&utm_content=ClinicalEdge%20Top%2010:%20Editor%27s%20Picks%20for%20May
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/woman-in-black-tank-top-holding-an-umbrella-in-front-of-yellow-concrete-wall-57851/

A seemingly surprising increase in incidence of Endometrial Cancer

The ACOG 2017 saw several interesting results come out. One surprising result, presented at an oral presentation, appears to be a presentation about the increase in the incidence of Endometrial Cancer.

It appears that Endometrial Cancer rates were stable from 1999 to 2002, but then, since 2006 to 2014, the rates appear to have increased by 10%.

The authors were curious, as you and I might be, so they examined EC incidence through the Surveillance, Epidemiology, and End Result Program database from 1975 through 2014.

Factors affecting Endometrial Cancer

It appears that FDA approved hormonal therapies have dropped in number, and therefore the use of non FDA approved combinations of estrogen and estrogen+progesterone, which may not be enough to stop endometrial cancer.

Obesity, which has been increasing consistently, already a known risk factor, might be aggravated.

Study Limitations

The study, as stated by the authors themselves, is clearly not a randomized clinical trial, but an ecological study. Therefore, it is not sufficient to draw conclusions and yet, the findings, especially the coincidence of the use of non-approved hormonal therapy and the increase in endometrial cancer as well as factors such as obesity is quite interesting, and this should be flushed out further, perhaps with targeted studies. Women, in particular should be aware of risk factors and seek medical help in advance.

References

  1. A report on the study: http://www.mdedge.com/clinicalendocrinologynews/article/137805/gynecologic-cancer/endometrial-cancer-rates-increased?channel=247&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  2. The ACOG summary of the study: http://journals.lww.com/greenjournal/Abstract/2017/05001/Increased_Incidence_of_Endometrial_Cancer.19.aspx
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/beach-woman-sunrise-silhouette-40192/