Effects of Physician Supply on Early Detection of Breast Cancer

Background: There are few studies examining the effects of physician supply on health-related out­ comes. We hypothesized that increasing physician supply and, in particular, increasing primary care supply would be related to earlier detection of breast cancer. Methods: Information on incident cases of breast cancer occurring in Florida in 1994 (n = 11,740) was collected from the state cancer registry. Measures of physician supply were obtained from the 1994 AMA Physician Masterfile. The effects of physician supply on the odds of late-stage diagnosis were exam­ ined using multiple logistic regression. Results: There was no relation between overall physician supply and stage of breast cancer of diag­ nosis. Each 10th percentile increase in primary care physician supply, however, resulted in a 4% in­ crease in the odds of early-stage diagnosis (adjusted odds ratio = 1.04,95% confidence interval = 1.01-1.06). Conclusions: The supply of primary care physicians was significandy associated with earlier stage of breast cancer at diagnosis. This study suggests that an appropriate balance of primary care and spe­ cialty physician supply might be an important predictor of health outcomes. (J Am Board Fam Pract 2000;13:408-14.) Breast cancer is the most common cancer in women and the second leading cause of cancer mortality in women in the United States. In 1999 there were 176,300 estimated new cases of breast cancer and 43,700 deaths from breast cancer in the United States. 1 The 5-year survival rate is 97% for patients with local stage, but decreases to 78% for regional spread, and 22% for distant disease. 2 Later stage at diagnosis for breast cancer has been previ­ ously shown to be associated with certain patient characteristics, such as postmenopausal age, 3 African­ American race/-5 low education/ being unmar­