Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women’s Circle of Health Study
Table 5
Age-adjusted associations of breast care characteristics prior to breast cancer diagnosis and tumor clinicopathologic characteristics with initial mode of breast cancer detection among Black women aged 40-75 years.
Clinical breast exam compared to screening mammogram
Self-detection compared to screening mammogram
Age-adjusted
Age-adjusted
OR (95% CI)
OR (95% CI)
Breast care characteristics prior to breast cancer diagnosis
Ever received a doctor’s recommendation for a mammogram
No
1.00 (Referent)
1.00 (Referent)
Yes
0.70 (0.34, 1.47)
0.73 (0.53, 1.02)
Ever had a routine screening mammogram before breast cancer diagnosis
No
1.00 (Referent)
1.00 (Referent)
Yes
0.24 (0.11, 0.55)
0.38 (0.24, 0.60)
Interval between breast cancer diagnosis and most recent routine screening mammogram
<1 year
1.00 (Referent)
1.00 (Referent)
1 year
0.84 (0.24, 3.00)
0.71 (0.45, 1.12)
>1 year
1.99 (0.56, 7.03)
1.59 (1.00, 2.54)
Ever had a doctor perform a clinical breast exam(s) (CBE) before diagnosis
No
1.00 (Referent)
1.00 (Referent)
Yes – last CBE performed within the last year
1.47 (0.43, 4.99)
0.43 (0.30, 0.61)
Yes – last CBE performed more than one year ago
4.23 (1.22, 14.62)
1.13 (0.76, 1.67)
Ever performed breast self-exams (BSEs) before breast cancer diagnosis
No
1.00 (Referent)
1.00 (Referent)
Yes – BSEs performed less than once per month
1.04 (0.54, 2.02)
3.06 (2.06, 4.54)
Yes – BSEs performed at least once per month
0.37 (0.18, 0.78)
3.42 (2.38, 4.93)
Ever diagnosed with a benign breast disease before breast cancer diagnosis
No
1.00 (Referent)
1.00 (Referent)
Yes
0.84 (0.46, 1.55)
0.90 (0.7, 1.17)
Breast tumor clinicopathologic features
Tumor grade
Well/moderately differentiated
1.00 (Referent)
1.00 (Referent)
Poorly differentiated
0.95 (0.50, 1.81)
2.44 (1.86, 3.21)
SEER summary stage
In situ
0.22 (0.05, 0.94)
0.22 (0.12, 0.37)
Localized
1.00 (Referent)
1.00 (Referent)
Regional/distant
2.93 (1.59, 5.39)
3.21 (2.28, 4.47)
Tumor size (cm)
<1.0
1.00 (Referent)
1.00 (Referent)
1.0-2.0
3.54 (1.64, 7.65)
4.07 (2.85, 5.81)
>2.0
7.26 (3.41, 15.44)
14.64 (10.30, 20.80)
Lymph node status
Negative
1.00 (Referent)
1.00 (Referent)
Positive
2.99 (1.62, 5.51)
3.43 (2.58, 4.56)
Lymphovascular invasion present
No
1.00 (Referent)
1.00 (Referent)
Yes
1.92 (0.88, 4.18)
3.21 (2.24, 4.59)
Estrogen receptor (ER)
ER+
1.00 (Referent)
1.00 (Referent)
ER-
0.40 (0.16, 1.03)
2.06 (1.57, 2.70)
Molecular
ER+/PR+/HER2-
1.00 (Referent)
1.00 (Referent)
ER+/PR+/HER2+
1.57 (0.69, 3.56)
1.50 (0.98, 2.31)
ER-/PR-/HER2+
0.32 (0.04, 2.43)
1.87 (1.12, 3.11)
ER-/PR-/HER2-
0.48 (0.17, 1.39)
2.17 (1.56, 3.01)
As shown in Table 3, percent unknown for tumor characteristics in the overall study sample was as follows: tumor grade, 17.5%; SEER summary stage, 3.6%; tumor size (cm), 0.1%; lymph node status, 9.8%; lymphovascular invasion present, 19.6%; ER status, 0.3%; molecular subtype, 10.4%. Molecular subtypes were classified using surrogate classifications, based on immunohistochemical expression of ER and PR and overexpression or amplification of HER2 (by immunohistochemistry or fluorescence in situ hybridization) as reported in pathology records.
