This study assesses the progress of cancer control efforts to detect early-stage breast cancer among non-whites and women from socioeconomically disadvantaged environments in Connecticut. Cancer incidence data were obtained from the SEER-supported Connecticut Tumor Registry for the period from 1986 to 1995. Community-level SES data were used.

From 1986 to 1995, the total number of incident breast cancer cases grew by 17%. Much, but not all, of the absolute increase was attributed to change in the size and composition of the state's female population. The annual age-adjusted incidence rate for early disease diagnosis increased by 3.1% (95% confidence interval=1.7% to 4.5% increase); the annual age-adjusted incidence by late-stage disease diagnosis decreased by 3.2% (95% confidence interval=2.2% to 4.2% decrease). After controlling for year of diagnosis, younger age (less than 40 years), non-white race, and middle and low SES standing by census tract all predicted diagnosis of late-stage disease. The adjusted odds ratio (OR) for less than 40 years versus 50-69 years of age was 1.67 (95% confidence interval = 1.41 to 1.98); the adjusted OR for non-white versus white, non- Hispanic race was 1.29 (95% confidence interval = 1.15 to 1.45); and the adjusted OR for lowest versus highest SES was 1.30 (95% confidence interval = 1.18 to 1.42). An evaluation of interactions revealed that the race and SES differences diminished in the last 5-year period.

The authors note that "merely discovering that women who reside in communities of low-to-moderate SES standing have a greater likelihood of diagnosis with late-stage disease than others is not enough; we need to discover whether this later diagnosis occurs because the women are disadvantaged, or because the relative deprivation of the communities places them at risk." The authors also note that the greater likelihood of late/stage diagnosis among non-white racial/ethnic groups "may point to well-established group differences in the etiology and course of disease. However one cannot disregard the reality of American society, where persistent residential and economic segregation differential exposure of individuals according to race/ethnicity to etiologic and health care delivery factors as an explanation of observed differences in disease stages." They note the changes in recent year are more likely to be explained by these social rather than biological changes.

The authors conclude that cancer control practitioners are advised to continue efforts to reduce social difference between groups in order to improve detection and disease course in at risk populations.