1. GEOGRAPHIC DISTRIBUTION OF BREAST CANCER IN MISSOURI, 1996 - 2007 Faustine Williams, MS., MPH, Stephen Jeanetta, Ph.D. Department of Rural Sociology, Division of Applied Social Sciences, College of Agriculture, Food and Natural Resources University of Missouri, Columbia, MO Introduction Breast cancer is the most frequent malignancy affecting women worldwide apart from skin cancer. One in eight women is affected. In 2010, an estimated 207,090 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 54,010 new cases of non- invasive. The stage at cancer diagnosis has a tremendous impact on type of treatment, recovery and survivability. In most cases the earlier the cancer is detected and treated the higher the survival rate for the patient. Various studies have indicated disparities in access to primary care especially access to screening services like mammogram for early detection. Breast cancer is the most frequent malignancy affecting women worldwide apart from skin cancer. One in eight women is affected. In 2010, an estimated 207,090 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 54,010 new cases of non- invasive. The stage at cancer diagnosis has a tremendous impact on type of treatment, recovery and survivability. In most cases the earlier the cancer is detected and treated the higher the survival rate for the patient. Various studies have indicated disparities in access to primary care especially access to screening services like mammogram for early detection. Purpose To examine the role of spatial access to health care services on incidence of female breast cancer in Missouri. Methods Based on the assumption that early diagnosis reflects better access to healthcare services like screening centers and distant cases reflect lack of preventive services, geostatistical analysis was used to compute the proportions of female breast cancer cases in each geographic location diagnosed at early and late stages. The addresses of healthcare providers participating in the breast and cervical cancer program were geocoded and used to calculate patient travel time from one provider to another. The figures and tables below show the spatial cluster of female breast cancer in Missouri from 1996-2007. CountyRegionIncidence MadisonRural1.52 McDonaldMetropolitan1.40 MariesRural1.33 BentonRural1.29 CharitonRural1.27 ShelbyRural1.24 WorthRural1.22 CamdenRural1.20 St. Louis CountyMetropolitan1.19 AtchisonRural1.14 CountyRegionIncidence AdairMicropolitan0.74 DeKalbMetropolitan0.74 NodawayMicropolitan0.73 ShannonRural0.73 MoniteauMetropolitan0.72 WashingtonMetropolitan0.69 PulaskiMicropolitan0.66 Ste GenevieveRural0.62 PemiscotRural0.61 MarionMicropolitan0.24 Figure 3. Highest and Lowest Early Stage Incidence by County and Region Figure 4. Highest and Lowest Late Stage Incidence by County and Region Figure 1. Flow chart showing methods and analysis process Figure 5. Distribution of screening center by Region and County Between 1996 and 2007, there were a total of 55,182 female breast cancers cases reported in Missouri. Out of these, 38,089 (69%) were diagnosed at early stage and 17,093 (31%) were late stage. In addition, a large geographic difference exists in proportions of women diagnosed in the state. Eight of the top 10 total incidence cases per county by population were in rural areas. While there are over 170 screening centers across the state, access to these services are not evenly distributed. A Euclidean analysis also showed that the distance traveled to healthcare providers for services vary from 9.0 miles to 77.0 miles. Between 1996 and 2007, there were a total of 55,182 female breast cancers cases reported in Missouri. Out of these, 38,089 (69%) were diagnosed at early stage and 17,093 (31%) were late stage. In addition, a large geographic difference exists in proportions of women diagnosed in the state. Eight of the top 10 total incidence cases per county by population were in rural areas. While there are over 170 screening centers across the state, access to these services are not evenly distributed. A Euclidean analysis also showed that the distance traveled to healthcare providers for services vary from 9.0 miles to 77.0 miles. Conclusions Women living in areas with limited access to health care services are more likely to be diagnosed with late stage breast cancer. In addition, since spatial access to primary healthcare services is critically important for early breast cancer detection, it is necessary for policy makers in the State to ensure that there is equitable access to these services in all counties. Limitations and Future Study All analyses in this study were based solely on number of female breast cancer cases (pure count) and zip code of provider centers. Other factors such as race and ethnicity, age, income and addresses of patients were not available due to IRB restrictions. In addition, the number of unknown cases; cases that were detected at death (Death Certificate Only) were also not included in our study. It is therefore important that future study take these essential issues into account. References American Cancer Society, (2011). Facts & Figures 2011. Wang, F., McLafferty, S., Escamilla, V. & Luo, L. (2008). Late-Stage Breast Cancer Diagnosis and Health Care Access in Illinois. Professional Geographer 60(1): 54–69 American Cancer Society, (2011). Facts & Figures 2011. Wang, F., McLafferty, S., Escamilla, V. & Luo, L. (2008). Late-Stage Breast Cancer Diagnosis and Health Care Access in Illinois. Professional Geographer 60(1): 54–69 Results Figure 6. Travel time to health provider in miles Table 1. Highest Incidence Counties Figure 2. Distribution of cancer incidence by County Table 2. Lowest Incidence Counties