Breast Cancer Survival by Inflammatory Status, Sociodemographic, Tumor, and Treatment Characteristics in the Surveillance, Epidemiology, and End Results (SEER) Database, 1990-2008

s / Annals of Epidemiology 22 (2012) 661e680 664 P12-S. Breast Cancer Survival by Inflammatory Status, Sociodemographic, Tumor, and Treatment Characteristics in the Surveillance, Epidemiology, and End Results (SEER) Database, 1990-2008 J.A. Schlichting, A.S. Soliman, C. Schairer, D. Schottenfeld, S.D. Merajver. Department of Epidemiology, University of Michigan, Ann Arbor, MI Purpose: Although it has been previously reported that patients with inflammatory breast cancer (IBC) experience worse survival than patients with other breast cancer (BC) types, the sociodemographic factors leading to this survival difference are not fully understood. Methods: Stage and inflammatory status stratified Kaplan-Meier survival curves and proportional hazards models were used to examine the association between BC specific (BCS) survival and county-level poverty, an index combining poverty and percent less than high school graduates, and rural vs. urban residence in the US SEER database linked to census derived county attributes. Results: Kaplan-Meier survival curves indicated IBC has worse survival than stage matched non-IBC, (Stage III IBC median survival1⁄44.75 years vs. Stage III non-IBC1⁄413.4 years, p< 0.0001). Residing in a lower socioeconomic position (SEP), rural county appears to worsen BCS survival, though only significantly for non-IBC in proportional hazards models (HR (95% CI) low vs. high SEP: Stage III IBC1⁄41.09 (0.95-1.25), Stage III non-IBC1⁄41.10 (1.02-1.18). African American cases appear to have worse BCS survival regardless of inflammatory status or county SEP. Conclusion: IBC interventions educating women on IBC symptoms, early detection, and treatment options should target women in various sociodemographic groups. Programs designed specifically for African American women may be especially helpful. P13-S. Identifying Mediators of the Racial/Ethnic Disparity in Breast Cancer Treatment Delay A. Silva, G.H. Rauscher. Division of Epidemiology and Biostatistics, University of Illinois at Chicago Purpose: Treatment delay may lead to higher rates of breast cancer recurrence and mortality. This study explores the role of patient (e.g. SES, medical mistrust) and health care factors (eg. insurance, cancer program type) in the racial/ethnic disparities in treatment delay. Methods: Interview and medical record data come from a population based sample of 989 female breast cancer patients age 30-79 years. Treatment delay was defined as a time from initial biopsy to first treatment exceeding 60 days. Age-adjusted risk differences (RDs) were estimated using logistic regression (with marginal standardization). Potential mediators related to delay were identified, and then assessed by rescaling model coefficients using the method of Karlson, Holm, and Breen. Results: Compared to nHWhitewomen, nH Black and Hispanic womenwere more likely to experience treatment delay (11% vs. 19% and 20%, respectively, p1⁄40.007). This minority-nH White disparity in treatment delay was present in women with radiologic detection (RD1⁄40.11, 95% CI: 0.05-0.18) but not in those with symptomatic detection (RD1⁄40.04, 95% CI: -0.4-0.12). Household income, type of insurance, and trust in diagnosing doctors mediated 46% of the treatment delay disparity in women radiologic detection (p1⁄40.008). Conclusions: The racial/ethnic disparity in treatment delay is most evident in women with radiologically detected tumors. Almost half of the disparity may be reduced by addressing access to care issue and improving trust in the doctor-patient relationship. P14-S. Mutable Factors Mediate Racial/Ethnic Disparities in the Delay of Breast Cancer Diagnoses A. Silva, G.H. Rauscher. Division of Epidemiology and Biostatistics, University of Illinois at Chicago Purpose: Breast cancer diagnosis delays may lead to later stage tumors and poorer prognoses. This study explores racial/ethnic disparities in diagnostic delay and the mediating role of patient (e.g. SES, medical mistrust) and health care factors (eg. insurance, cancer program type). Methods: Interviews and medical records were obtained from a population-based sample of 989 female breast cancer patients age 30-79 years. Diagnostic delay was defined as the time from medical presentation to initial biopsy exceeding 60 days. Age-adjusted risk differences (RDs) were estimated using logistic regression (with marginal standardization). Potential mediators related to delay were identified, and then assessed by rescaling model coefficients using the method of Karlson, Holm, and Breen. Results: Compared to nH White women, nH Black and Hispanic women were more likely to experience diagnostic delay (12% vs. 26% and 33%, respectively, p1⁄40.000). This minority-nH White disparity was largest in women with radiologic detection (RD1⁄40.22, 95% CI: 0.13-0.29) where 53% of the disparity was explained by income, type of insurance, breast cancer misconceptions, and the presence of an accredited breast cancer program (p1⁄40.001). Alternatively, the disparity was less in those with symptomatic detection (RD1⁄40.09, 95% CI: 0.0-0.19) where income, insurance, and medical mistrust explained 87% of the disparity (p1⁄40.03). Conclusions: Minority women face a longer time to breast cancer diagnosis. Addressing inequities in care and other mutable factors may ameliorate this disparity. P15-S. Racial Disparities in Religious Beliefs and Colon Cancer Detection K.C. Brewer, G. Rauscher, B. Polite. Dept of Epidemiology, University of Illinois at Chicago, University of Chicago Medicine Purpose: African Americans (AA) in the United States are diagnosed with colon cancer at later stages and have lower survival rates than their White (WA) counterparts. Recent research has suggested that personal religious beliefs may have an impact on cancer outcomes through altering healthcareseeking behaviors and mode of detection. Methods: Differences in religious practices and religion in health and coping were assessed using interview data (GLHC, RPS, and RCOPE scales) from 83 (45 WA and 38 AA) Chicago-area patients. Pooled categorical variables for each scale were created using Cronbach's alpha correlation procedures. Distributions of all study variables were examined by race and mode of detection. Multivariate logistic models were created to determine the association between religious beliefs and mode of detection. Results: In this preliminary sample of colon cancer patients, AA reported significantly stronger religious practices and greater use of religion in health and in coping (p < 0.0001 for all). AA were marginally more likely to report symptomatic detection of cancer than Whites (42% vs. 37%). In adjusted logistic models, religious beliefs and religion in health and coping were marginally associated with symptomatic colon cancer detection and significantly associated with lower levels of health care utilization. Conclusion: Differences in religion and use of religion in health and coping may help explain racial disparities in symptomatic detection. Results presented will include roughly twice as many patients. Additional analyses will examine mechanisms by which these religious factors may impede or facilitate early detection via health care utilization. P16-S. Fruit and Vegetable Intake and Risk of Colorectal Cancer: Results From the Shanghai Men's Health Study (SMHS) E. Vogtmann, H.L. Li, Y.B. Xiang, G. Yang, W. Zheng, X.O. Shu. Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China and Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN Purpose: To evaluate the association between fruits and vegetables on the risk of colorectal cancer (CRC) in the SMHS. Methods: 59,645 SMHS participants recruited between 2002 and 2006 with follow-up through December 31, 2009 were included in the study. A validated food frequency questionnaire was administered to collect information on daily intakes, including 8 fruits and 40 vegetables commonly consumed by residents of Shanghai. Dietary intakes were categorized into quintiles and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox regression models with adjustment for potential confounders. Results: A total of 259 cases of CRC were observed during follow-up. We did not find that total fruit intake, with a HR of 0.75 (95% CI: 0.50, 1.12), nor total vegetable intake, with a HR of 1.06 (95% CI: 0.71, 1.58) for the 5th vs. the 1st