Carcinoma detection at the breast examination center of Harlem

• Published in: Cancer Vol. 95; no. 1; pp. 8 - 14
• Main Authors: Liberman, Laura, Freeman, Harold P., Chandra, Sukanya, Stein, Amanda L., Mccord, Colin, Godfrey, Diana, Dershaw, D. David
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.07.2002; Wiley-Liss
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; breast carcinoma; breast neoplasms; Breast Neoplasms - diagnosis; Breast Neoplasms - pathology; Breast Neoplasms - therapy; diagnosis; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Mammography; Medical sciences; Middle Aged; Neoplasm Staging; Retrospective Studies; Tumors; New York; United States; North America; America; Human; Mammary gland diseases; Carcinoma; Radiodiagnosis; Clinical investigation; Mammography; Malignant tumor; Diagnosis; Mammary gland; Medical screening; Public health
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.10640

BACKGROUND Breast carcinoma is one of the leading causes of excess mortality rates in Harlem, an inner‐city neighborhood with the highest mortality rates and worst life expectancy in New York City. This study reports the results of a breast carcinoma screening and diagnostic program in Harlem. METHODS Retrospective review was performed of a database of 49,750 visits to the Breast Examination Center of Harlem from 1995 to 2000. During this period, 181 breast carcinomas were diagnosed in 178 women. The medical records of these 178 women were reviewed to determine the method of detection, stage, and treatment. RESULTS Among these women, 89% were black or Hispanic, 45% had no medical insurance, and 38% had incomes below federal poverty guidelines. Breast carcinoma stage, known for 167 carcinomas, was Stage 0 in 38 (23%), Stage I in 38 (23%), Stage II in 63 (38%), Stage III in 24 (14%), and Stage IV in 4 (2%). Fifty‐six cases (34%) were minimal breast carcinomas. Of 181 breast carcinomas, 122 (67%) were palpable and 59 (33%) were nonpalpable, detected only by mammography in asymptomatic women. Nonpalpable, as opposed to palpable, breast carcinomas were significantly more likely to be ductal carcinoma in situ (30 of 55 [54%] vs. 8 of 112 [7%], P < 0.0000001) or minimal breast carcinoma (39 of 55 [71%] vs. 17 of 112 [15%], P = 0.0000001) and were more likely to be treated with breast‐conserving surgery (47 of 56 [84%] vs. 76 of 110 [69%], P < 0.04). CONCLUSIONS A breast carcinoma screening and diagnostic program has been established in Harlem, a traditionally underserved area in New York City. Early, curable breast carcinomas were detected but outreach remains a challenge, particularly for the uninsured. Cancer 2002;95:8–14. © 2002 American Cancer Society. DOI 10.1002/cncr.10640 A breast carcinoma screening and diagnostic program has been established in Harlem, an underserved area that has the highest mortality rates and worst life expectancy in New York City. Early and curable cancers were detected but outreach remains a challenge, particularly for the uninsured.