Stage of breast and cervical cancer diagnosis in disadvantaged neighborhoods: a prevention policy perspective.

Public health research on cancer and socioeconomic status (SES) has shown that higher SES is related to greater access to services. Using neighborhood-level measures of SES, we test hypotheses related to stage of breast and cervical cancer diagnosis. SEER data on women diagnosed with breast or cervical cancer in 1989 and 1990 in San Francisco, Atlanta, and Detroit were matched with 1990 Census tract data. Cases were grouped as "in situ" or "invasive" at diagnosis. Using multivariate logistic regression in two separate models, we investigated whether residence in a poverty-tract or, alternatively, a disadvantaged neighborhood is associated with increased likelihood of diagnosis with invasive tumors. Living in a socioeconomically disadvantaged neighborhood was a strong, consistent predictor of invasive cancer. Living in a neighborhood with a high proportion of households in poverty was also a significant predictor for cervical cancer. Our results suggest specific neighborhoods that would benefit from clinical interventions. Lack of economic and social resources constrains individuals living in these neighborhoods from taking advantage of interventions targeting individual behavior. Thus, interventions in the small proportion of disadvantaged neighborhoods, we argue, need to target the entire community. Further, policy reform at the community level becomes more feasible when need can be specified for a particular census tract.