Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women’s Circle of Health Study
Table 6
Multivariable logistic regression analysis of the factors associated with mode of detection among Black women aged 40-75 years.
Characteristic
Clinical breast exam compared to screening mammogram
Self-detection compared to screening mammogram
Multivariable-adjusted
Multivariable-adjusted
OR (95% CI)
OR (95% CI)
Primary health insurance at diagnosis
Private
1.00 (Referent)
1.00 (Referent)
Medicaid
0.99 (0.31, 3.15)
1.03 (0.59, 1.82)
Medicare
1.84 (0.63, 5.38)
0.83 (0.48, 1.43)
Uninsured
0.58 (0.14, 2.37)
1.38 (0.77, 2.47)
Other
0.31 (0.04, 2.63)
0.92 (0.46, 1.83)
Body mass index (kg/m2)
<25.0
1.33 (0.49, 3.62)
2.46 (1.52, 3.98)
25.0-29.99
0.79 (0.32, 1.95)
1.07 (0.70, 1.64)
30.0-34.99
1.22 (0.50, 2.97)
0.80 (0.50, 1.26)
≥35.0
1.00 (Referent)
1.00 (Referent)
History of hormone therapy use
No
1.00 (Referent)
1.00 (Referent)
Yes
0.61 (0.23, 1.63)
0.62 (0.39, 0.97)
Ever had a routine screening mammogram before breast cancer diagnosis
No
1.00 (Referent)
1.00 (Referent)
Yes
0.20 (0.07, 0.54)
0.52 (0.27, 1.00)
Ever had a doctor perform a clinical breast exam(s) (CBE) before breast cancer diagnosis
No
1.00 (Referent)
1.00 (Referent)
Yes – last CBE performed within the last year
4.33 (0.90, 20.83)
0.48 (0.29, 0.79)
Yes – last CBE performed more than one year ago
11.04 (2.24, 54.55)
1.28 (0.74, 2.20)
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
0.92 (0.42, 2.01)
4.08 (2.45, 6.78)
Yes – BSEs performed at least once per month
0.31 (0.13, 0.74)
4.99 (3.13, 7.97)
Breast tumor clinicopathologic features
Tumor gradea
Well/moderately differentiated
1.00 (Referent)
1.00 (Referent)
Poorly differentiated
0.65 (0.28, 1.47)
1.19 (0.80, 1.77)
SEER summary stage
In situ
0.44 (0.02, 9.20)
0.65 (0.21, 2.05)
Localized
1.00 (Referent)
1.00 (Referent)
Regional/distant
4.39 (0.78, 24.83)
1.98 (0.92, 4.27)
Tumor size (cm
<1.0
1.00 (Referent)
1.00 (Referent)
1.0-2.0
2.13 (0.83, 5.44)
2.92 (1.84, 4.64)
>2.0
3.17 (0.88, 11.42)
6.41 (3.30, 12.46)
Lymph node
Negative
1.00 (Referent)
1.00 (Referent)
Positive
1.54 (0.54, 4.34)
1.62 (0.93, 2.81)
Lymphovascular invasion
No
1.00 (Referent)
1.00 (Referent)
Yes
1.18 (0.48, 2.87)
1.35 (0.84, 2.18)
Estrogen receptor (ER)
ER+
1.00 (Referent)
1.00 (Referent)
ER-
-
1.13 (0.42, 3.07)
Molecular
ER+/PR+/HER2-
1.00 (Referent)
1.00 (Referent)
ER+/PR+/HER2+
1.44 (0.53, 3.91)
1.08 (0.61, 1.91)
ER-/PR-/HER2+
-
1.44 (0.45, 4.63)
ER-/PR-/HER2-
-
1.69 (0.59, 4.82)
Note: odds ratios (ORs) and 95% confidence intervals (Cis) were generated using multivariable models, mutually adjusting for all variables shown in the table as well as for age. 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.
