Breast cancer in a county hospital population: Impact of breast screening on stage of presentation

A. Marilyn Leitch, Ronald F. Garvey

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Indigent patients in a county hospital setting typically present with breast cancer at a later stage than do patients in the private sector. In the early 1980s, 50% of all breast cancers diagnosed in our county hospital were stages III and IV. This contrasted markedly with the findings of an American College of Surgeons study, which showed <15% of breast cancers diagnosed as stages III and IV. Methods: Recognizing this disparity, we instituted a breast screening project in the county teaching hospital targeted at women who routinely received medical care in the county hospital clinics. Between 1985 and 1992, 14,567 mammograms were performed. Results: Two hundred eighty-nine breast biopsies were performed and 76 cancers were identified (26%). Ninety-five patients advised to have surgical consultation for biopsy declined further evaluation. The stage distribution of cancers diagnosed was as follows: stage 0, 20%; stage I, 43%; stage II, 28%; stage III, 8%; and stage IV, 1%. This compares favorably with National Cancer Data Base statistics for 1988. In contrast, symptomatic nonscreened patients diagnosed at the county hospital in 1992 presented at a significantly more advanced stage: stage 0, 1%; stage I, 14%; stage II, 45%; stage III, 26%; and stage IV, 13%. Conclusions: Mammographic screening has lowered the stage of cancers diagnosed in the screened indigent population. However, a significant percentage of patients are presenting to our hospital with stage III and IV disease. Problems identified in the screening project included noncompliance with recommendations for follow-up of abnormal studies and noncompliance with appointments. In order to broaden the impact of our breast screening project, we have instituted outreach programs with community-based clinics and the American Cancer Society.

Original languageEnglish (US)
Pages (from-to)516-520
Number of pages5
JournalAnnals of Surgical Oncology
Volume1
Issue number6
DOIs
StatePublished - Nov 1994

Fingerprint

County Hospitals
Breast
Breast Neoplasms
Population
Poverty
Neoplasms
Biopsy
Private Sector
Teaching Hospitals
Appointments and Schedules
Referral and Consultation
Databases

Keywords

  • Breast
  • Indigent women
  • Screening

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Breast cancer in a county hospital population : Impact of breast screening on stage of presentation. / Leitch, A. Marilyn; Garvey, Ronald F.

In: Annals of Surgical Oncology, Vol. 1, No. 6, 11.1994, p. 516-520.

Research output: Contribution to journalArticle

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abstract = "Background: Indigent patients in a county hospital setting typically present with breast cancer at a later stage than do patients in the private sector. In the early 1980s, 50{\%} of all breast cancers diagnosed in our county hospital were stages III and IV. This contrasted markedly with the findings of an American College of Surgeons study, which showed <15{\%} of breast cancers diagnosed as stages III and IV. Methods: Recognizing this disparity, we instituted a breast screening project in the county teaching hospital targeted at women who routinely received medical care in the county hospital clinics. Between 1985 and 1992, 14,567 mammograms were performed. Results: Two hundred eighty-nine breast biopsies were performed and 76 cancers were identified (26{\%}). Ninety-five patients advised to have surgical consultation for biopsy declined further evaluation. The stage distribution of cancers diagnosed was as follows: stage 0, 20{\%}; stage I, 43{\%}; stage II, 28{\%}; stage III, 8{\%}; and stage IV, 1{\%}. This compares favorably with National Cancer Data Base statistics for 1988. In contrast, symptomatic nonscreened patients diagnosed at the county hospital in 1992 presented at a significantly more advanced stage: stage 0, 1{\%}; stage I, 14{\%}; stage II, 45{\%}; stage III, 26{\%}; and stage IV, 13{\%}. Conclusions: Mammographic screening has lowered the stage of cancers diagnosed in the screened indigent population. However, a significant percentage of patients are presenting to our hospital with stage III and IV disease. Problems identified in the screening project included noncompliance with recommendations for follow-up of abnormal studies and noncompliance with appointments. In order to broaden the impact of our breast screening project, we have instituted outreach programs with community-based clinics and the American Cancer Society.",
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