Despite advances in early cancer detection, racial and ethnic minority individuals seem to be more likely to have a late-stage diagnosis of cancers that have a recommended screening. A large study by the American Cancer Society that examined the association between neighborhood-level segregation and stage at diagnosis has found that racialized-economic segregation in New York City was associated with higher advanced-stage diagnoses of breast and cervical cancer—but not colorectal cancer. The findings may partially reflect both structural barriers that delay timely diagnosis and the impact of local equity-driven initiatives that broaden colorectal cancer screening access, according to the study authors. The study by Liu et al wass published in the Journal of the National Cancer Institute.
Study Methodology
The researchers analyzed nearly 100,000 cases of breast (58,970), cervical (4,790), and colorectal (34,689) cancers using New York State Cancer Registry data (2008–2019). Census tract-level neighborhood–Index of Concentration at Extremes measures of racial and/or income-based economic segregation were calculated. Age-adjusted stage-specific incidence rates and advanced-to-localized incidence rate ratios (IRRs) were measured across n-ICE quartiles.
Key Results
The researchers found that advanced-to-localized stage IRRs were significantly higher in the most-deprived and/or non-Hispanic Black (NHB)-concentrated areas (Q1) than the most-affluent and/or most non-Hispanic White (NHW)-concentrated areas (Q4) for breast and cervical cancer (all P values < .01). They also found that Hispanic concentration alone was not associated with disparities but combined with economic deprivation was (all P values < .01). All racialized-economic segregation measures showed increasing IRRs with higher segregation for both cancers (all P trend < .04). The researchers observed no disparities for colorectal cancer.
“Racialized-economic segregation in New York City was associated with higher advanced-stage diagnoses of breast and cervical cancer but not colorectal cancer. These findings may partially reflect both structural barriers that delay timely diagnosis and the impact of local equity-driven initiatives that broaden colorectal cancer screening access,” concluded the study authors.
Clinical Significance
“Our findings have direct implications for cancer prevention and early detection efforts by identifying neighborhoods with the greatest disparities in stage at diagnosis,” said Qinran Liu, PhD, MPH, a postdoctoral fellow, cancer disparities research at the American Cancer Society, in a statement. “This information can inform targeted resource allocation and guide interventions, such as patient navigation services and investments in health-care infrastructure—strategies that can facilitate earlier diagnosis with the goal of improving outcomes.”
Dr. Liu, of the American Cancer Society, is the corresponding author of this study.
Disclosure: Funding for this study was provided by the American Cancer Society. The study authors reported no conflicts of interest.
