Skip to main content
Log in

Race, socioeconomic status and stage at diagnosis for five common malignancies

  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Background: African-Americans are more likely than Caucasians to be diagnosed at an advanced stage of colorectal, lung, breast, cervical, and prostate cancers. This study explores if racial differences in stage at diagnosis can be explained by socioeconomic status (SES) differences. Previous studies investigating this association have used aggregate SES indicators from census tract of residence; we used census block-group data, representing a smaller, potentially more homogenous group. Methods: We included all African-American and Caucasian invasive cancers of the colon and rectum, lung and bronchus, female breast, cervix uteri, and prostate that were diagnosed between January 1, 1988 and December 31, 1992 in the Detroit area. Stage of disease at diagnosis was grouped as local or non-local. An SES value was calculated for each case using aggregate 1990 US Census data for education, poverty status, and occupation specific to each case's census block-group. Logistic regression analysis was used to model the probability of non-local stage using SES, race, age group, and sex as covariates. Results: SES was an independent predictor of stage at diagnosis for each cancer site, with cases from the highest SES block-group more likely to present with local stage disease than those from the lowest SES group. Race independently predicted stage only for breast and prostate cancers; African-Americans presented with more advanced stage than Caucasians. Conclusions: Based on census block-group aggregate data, SES is an important predictor of stage at diagnosis, most likely accounting for much of the disparity in stage between African-Americans and Caucasians for colorectal, lung, and cervical cancers. Biological factors may play a role in racial disparities for breast and prostate cancer stage at diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ries L, Eisner M, Kosary C, Hankey B, Miller B, Clegg L, et al. (2002) SEER Cancer Statistics Review, 1973-1999. Vol. 2002, Bethesda, MD: National Cancer Institute.

    Google Scholar 

  2. Suarez L, Pulley L (1995) Comparing acculturation scales and their relationship to cancer screening among older Mexican-American women. J Natl Cancer Inst Mongr 41-47.

  3. Hegarty V, Burchett B, Gold D, Cohen H (2000) Racial differences in use of cancer preventive services among older Americans. J Am Geriatr Soc 48: 735-740.

    Google Scholar 

  4. Sung HY, Kearney KA, Miller M, Kinney W, Sawaya GF, Hiatt RA (2000) Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan. Cancer 88: 2283-2289.

    Google Scholar 

  5. Baquet CR, Commiskey P (2000) Socioeconomic factors and breast carcinoma in multicultural women. Cancer 88: 1256-1264.

    Google Scholar 

  6. Breen N, Figueroa JB (1996) Stage of breast and cervical cancer diagnosis in disadvantaged neighborhoods: a prevention policy perspective. Am J Prev Med 12: 319-326.

    Google Scholar 

  7. Figueroa JB, Breen N (1995) Significance of underclass residence on the stage of breast or cervical cancer diagnosis. Am Econ Rev 85: 112-116.

    Google Scholar 

  8. Bennett CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, et al. (1998) Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. J Clin Oncol 16: 3101-3104.

    Google Scholar 

  9. Dalaker J (2001) Poverty in the United States: 2000. Government Printing Office, Washington DC: US Census Bureau, Current Population Reports.

    Google Scholar 

  10. Farley TA, Flannery JT (1989) Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications. Am J Public Health 79: 1508-1512.

    Google Scholar 

  11. Liu L, Deapen D, Bernstein L (1998) Socioeconomic status and cancers of the female breast and reproductive organs: a comparison across racial/ethnic populations in Los Angeles County, California (United States). Cancer Causes Control 9: 369-380.

    Google Scholar 

  12. Ndubuisi SC, Kofie VY, Andoh JY, Schwartz EM (1995) Black-white differences in the stage at presentation of prostate cancer in the District of Columbia. Urology 46: 71-77.

    Google Scholar 

  13. Polednak AP (1997) Stage at diagnosis of prostate cancer in Connecticut by poverty and race. Ethn Dis 7: 215-220.

    Google Scholar 

  14. Richardson JL, Langholz B, Bernstein L, Burciaga C, Danley K, Ross RK (1992) Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year. Br J Cancer 65: 922-926.

    Google Scholar 

  15. Roetzheim RG, Pal N, Tennant C, Voti L, Ayanian JZ, Schwabe A, et al. (1999) Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst 91: 1409-1415.

    Google Scholar 

  16. US Census Bureau (2002) Geographic Terms and Concepts. http:// www.census.gov/www/reference.html.

  17. US Census Bureau (1991) Census of Population and Housing (1990) Summary Tape File 3 Technical Documentation. Washington DC: US Census Bureau.

    Google Scholar 

  18. Krieger N, Quesenberry C, Jr., Peng T, Horn-Ross P, Stewart S, Brown S, et al. (1999) Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among asian, black, Race, SES and stage at diagnosis 765 hispanic, and white residents of the San Francisco Bay Area, 1988-1992 (United States). Cancer Causes Control 10: 525-537.

    Google Scholar 

  19. Behavioral Risk Factor Surveillance System (2000) Centers for Disease Control and Prevention. http: //www.cdc.gov/brfss/.

  20. Sawaya GF, Sung HY, Kearney KA, Miller M, Kinney W, Hiatt RA, et al. (2001) Advancing age and cervical cancer screening and prognosis. J Am Geriatr Soc 49: 1499-1504.

    Google Scholar 

  21. Chen VW, Fenoglio-Preiser CM, Wu XC, Coates RJ, Reynolds P, Wickerham DL, et al. (1997) Aggressiveness of colon carcinoma in blacks and whites. National Cancer Institute Black/White Cancer Survival Study Group. Cancer Epidemiol Biomarkers Prev 6: 1087-1093.

    Google Scholar 

  22. Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J (1996) The late-stage diagnosis of colorectal cancer: demographic and socioeconomic factors. Am J Public Health 86: 1794-1797.

    Google Scholar 

  23. Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR, Kramer B (1995) Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system. JAMA 274: 1599-1605.

    Google Scholar 

  24. Spitler HD, Mayo RM, Parker VG (2001) Patterns of breast, cervical, colorectal, and prostate cancer in the Appalachian region of South Carolina. Ethn Dis 11: 51-59.

    Google Scholar 

  25. Marcella S, Miller JE (2001) Racial differences in colorectal cancer mortality. The importance of stage and socioeconomic status. J Clin Epidemiol 54: 359-366.

    Google Scholar 

  26. Mayberry RM, Coates RJ, Hill HA, Click LA, Chen VW, Austin DF, et al. (1995) Determinants of black/white differences in colon cancer survival. J Natl Cancer Inst 87: 1686-1693.

    Google Scholar 

  27. Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN, Muss HB, et al. (1994) Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 272: 947-954.

    Google Scholar 

  28. Lannin D, Mathews HJM, Swanson M, Swanson F, Edwards M (1998) Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA 279: 1801-1807.

    Google Scholar 

  29. Mandelblatt J, Andrews H, Kerner J, Zauber A, Burnett W (1991) Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type. Am J Public Health 81: 646-649.

    Google Scholar 

  30. Hoffman RM, Gilliland FD, Eley JW, Harlan LC, Stephenson RA, Stanford JL, et al. (2001) Racial and ethnic differences in advanced-stage prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst 93: 388-395.

    Google Scholar 

  31. Merkin S, Stevenson L, Powe N (2002) Geographic socioeconomic status, race, and advanced-stage breast cancer in New York City. Am J Public Health 92: 64-70.

    Google Scholar 

  32. Li A, Burton G, Glass J (2001) Breast cancer: a socioeconomic and racial comparison in northwest Louisiana. J La State Med Soc 153: 420-425.

    Google Scholar 

  33. Greenwald HP, Polissar NL, Borgatta EF, McCorkle R, Goodman G (1998) Social factors, treatment, and survival in earlystage non-small cell lung cancer. Am J Public Health 88: 1681-1684.

    Google Scholar 

  34. Dominitz JA, Samsa GP, Landsman P, Provenzale D (1998) Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system. Cancer 82: 2312-2320.

    Google Scholar 

  35. The National Cancer Institute (2002) SEER Cancer Incidence Public Use Database, 1973-1999. SEER*Stat 4.2. Information Management Services, Inc.

  36. Ries L, Kosary C, Hankey B, Miller BAH, Edwards BK (1997) SEER Cancer Statistics Review, 1973-1994, National Cancer Institute. Bethesda, MD: NIH Pub. No. 97-2789.

    Google Scholar 

  37. Kwok RK, Yankaskas BC (2001) The use of census data for determining race and education as SES indicators: a validation study. Ann Epidemiol 11: 171-177.

    Google Scholar 

  38. Geronimus AT, Bound J (1998) Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples. Am J Epidemiol 148: 475-486.

    Google Scholar 

  39. Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82: 703-710.

    Google Scholar 

  40. Roux AV, Kiefe CI, Jacobs DR, Jr, Haan M, Jackson SA, Nieto FJ, et al. (2001) Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Ann Epidemiol 11: 395-405.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kendra L. Schwartz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwartz, K.L., Crossley-May, H., Vigneau, F.D. et al. Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control 14, 761–766 (2003). https://doi.org/10.1023/A:1026321923883

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1026321923883

Navigation