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Association Between Dense Breast Legislation and Cancer Stage at Diagnosis

  • Chan Shen
    Correspondence
    Address correspondence to: Chan Shen, PhD, Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, 500 University Drive, H151, Hershey PA 17033.
    Affiliations
    Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

    Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

    Penn State Cancer Institute, Hershey, Pennsylvania
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  • Roger W. Klein
    Affiliations
    Department of Economics, Rutgers University, New Brunswick, New Jersey
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  • Jennifer L. Moss
    Affiliations
    Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

    Penn State Cancer Institute, Hershey, Pennsylvania

    Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Daleela G. Dodge
    Affiliations
    Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

    Penn State Cancer Institute, Hershey, Pennsylvania
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  • Alison L. Chetlen
    Affiliations
    Penn State Cancer Institute, Hershey, Pennsylvania

    Department of Radiology, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania
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  • Kelly A. Stahl
    Affiliations
    Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Shouhao Zhou
    Affiliations
    Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

    Penn State Cancer Institute, Hershey, Pennsylvania

    Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Douglas L. Leslie
    Affiliations
    Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Mack T. Ruffin
    Affiliations
    Penn State Cancer Institute, Hershey, Pennsylvania

    Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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  • Eugene J. Lengerich
    Affiliations
    Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania

    Penn State Cancer Institute, Hershey, Pennsylvania
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      Introduction

      Many states have mandated breast density notification and insurance coverage for additional screening; yet, the association between such legislation and stage of diagnosis for breast cancer is unclear. This study investigates this association and examines the differential impacts among different age and race/ethnicity subgroups.

      Methods

      The Surveillance, Epidemiology, and End Results database was queried to identify patients with breast cancer aged 40–74 years diagnosed between 2005 and 2016. Using a difference-in-differences multinomial logistic model, the odds of being diagnosed at different stages of cancer relative to the localized stage depending on legislation and individual characteristics were examined. Analyses were conducted in 2020–2021.

      Results

      The study included 689,641 cases. Overall, the impact of notification legislation was not significant, whereas insurance coverage legislation was associated with 6% lower odds (OR=0.94, 95% CI=0.91, 0.96) of being diagnosed at the regional stage. The association between insurance coverage legislation and stage of diagnosis was even stronger among women aged 40–49 years, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.96) of being diagnosed at the regional stage and 12% lower odds (OR=0.88, 95% CI=0.81, 0.96) of being diagnosed at the distant stage. Hispanic women benefited from notification laws, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.97) of being diagnosed at distant stage. Neither notification nor supplemental screening insurance coverage legislation showed a substantial impact on Black women.

      Conclusions

      The findings imply that improving insurance coverage is more important than being notified overall. Raising awareness is important among Hispanic women; improving communication about dense breasts and access to screening might be more important than legislation among Black women.
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