Open Access Highly Accessed Open Badges Research article

Neighborhood socio-economic disadvantage and race/ethnicity as predictors of breast cancer stage at diagnosis

Yvonne N Flores12*, Pamela L Davidson345, Terry T Nakazono36, Daisy C Carreon5, Cynthia M Mojica7 and Roshan Bastani1

Author Affiliations

1 UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Drive S., A2-125 CHS, Box 956900-6900, Los Angeles, CA 90095, USA

2 Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Blvd. Benito Juárez No. 31 Col. Centro, Cuernavaca, Morelos C.P. 62000, México

3 UCLA Clinical and Translational Science Institute, CTSI-Evaluation Sciences, 10880 Wilshire Blvd., Ste. 500, Los Angeles, CA 90024, USA

4 UCLA School of Nursing, 10880 Wilshire Blvd., Ste. 500, Los Angeles, CA 90024, USA

5 UCLA Department of Health Policy and Management, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA 90095-1772, USA

6 UCLA David Geffen School of Medicine, Division of General Internal Medicine & Health, Services Research, 911 Broxton Plaza, Ste. 101, Box 951736, Los Angeles, CA 90095-1736, USA

7 Institute for Health Promotion Research, Department of Epidemiology and Biostatistics, School of Medicine, Cancer Therapy & Research Center, the University of Texas Health Science Center at San Antonio, 7411 John Smith Dr., Suite 1000, San Antonio, TX 78229, USA

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BMC Public Health 2013, 13:1061  doi:10.1186/1471-2458-13-1061

Published: 11 November 2013



This study investigated the role of key individual- and community-level determinants to explore persisting racial/ethnic disparities in breast cancer stage at diagnosis in California during 1990 and 2000.


We examined socio-demographic determinants and changes in breast cancer stage at diagnosis in California during 1990 and 2000. In situ, local, regional, and distant diagnoses were examined by individual (age, race/ethnicity, and marital status) and community (income and education by zip code) characteristics. Community variables were constructed using the California Cancer Registry 1990-2000 and the 1990 and 2000 U.S. Census.


From 1990 to 2000, there was an overall increase in the percent of in situ diagnoses and a significant decrease in regional and distant diagnoses. Among white and Asian/Pacific Islander women, a significant percent increase was observed for in situ diagnoses, and significant decreases in regional and distant diagnoses. Black women had a significant decrease in distant -stage diagnoses, and Hispanic women showed no significant changes in any diagnosis during this time period. The percent increase of in situ cases diagnosed between 1990 and 2000 was observed even among zip codes with low income and education levels. We also found a significant percent decrease in distant cases for the quartiles with the most poverty and least education.


Hispanic women showed the least improvement in breast cancer stage at diagnosis from 1990 to 2000. Breast cancer screening and education programs that target under-served communities, such as the rapidly growing Hispanic population, are needed in California.

Breast cancer; Stage at diagnosis; Screening; Disparities