1. BREAST CANCER BY STAGE OF DISEASE AT DIAGNOSIS, CENTRAL OKLAHOMA Arthur Owora, MPH; Aaron Wendelboe, PhD; David Thompson, PhD; Janis Campbell, PhD The University of Oklahoma Health Sciences Center, College of Public health; Oklahoma City, Oklahoma BREAST CANCER BY STAGE OF DISEASE AT DIAGNOSIS, CENTRAL OKLAHOMA Arthur Owora, MPH; Aaron Wendelboe, PhD; David Thompson, PhD; Janis Campbell, PhD The University of Oklahoma Health Sciences Center, College of Public health; Oklahoma City, Oklahoma Background  Breast cancer stage IV disease incidence among women ≥40 years is an indicator of lack of early screening.  Populations with the highest overall incidence of breast cancer may not necessarily be the populations that need to be targeted, however, it is important if breast cancer incidence and/or diagnoses are measured by stage of disease.  Populations with high levels of stage IV breast cancer have likely not been screened previously; else cancer should have been detected before it progressed to stage IV. Methods  Secondary data sources: -Susan G. Komen for the Cure Central Oklahoma Affiliate 2007 data for the 10-county service area. -Oklahoma State Health Department Central Cancer registry for breast cancer 1997-2005 data.  Ecologic analysis of risk factors: age group, race/ethnicity, insurance status, family income, screening practices, year and stage of breast cancer at diagnosis.  Correlations summarized by Spearman rank-correlation coefficients and exact p values.  Jonckheere-Terpstra (JT ) test assessed distributional differences in breast cancer stage diagnosis (stage I to IV) across 10 counties.  Proportion of stage IV breast cancer diagnosis modeled on risk factors using robust regression with M estimators.  The full model was reduced term by term until all terms were significant (p<0.05). Potential confounding and interactions investigated. Results  Oklahoma County had highest proportion of stage IV breast cancer, followed by Logan County and the lowest proportion was seen in Cleveland, McClain and Canadian ; 4.6%, 4.5% and 4.2% respectively.  The percentage of stage IV disease in blacks was nearly double the percent of stage IV disease in white and other races; 8% vs. 4%,p<0.01 and 4%,p<0.01 respectively.  The distribution of breast cancer diagnoses by stage among females in age groups 50-64, 40-49 and 65+years did not differ (JT statistic=296, p=0.15).  Distribution of breast cancer at stage of diagnosis did not differ by family income, insurance status, screening practices or race by county (p>0.05).  A significant positive association (Spearman correlation coefficient =0.61, p=0.04) between % black females and %stage IV disease by county.  Univariate analysis Statistically significant associations:- Blacks 2.3% (95% CI: 1.7 to 3.0), Whites-1.4% (95% CI: -2.2 to -0.5), poverty level 2.2% (95% CI: 0.1 to 4.3). Non significant associations:- Uninsured 0.5% (95% CI: -0.1 to 2.0), Females 65+ years 1.4% (95% CI: -2.2 to 5.0).  The association between Blacks and stage IV diagnosis did not appear to be confounded by the investigated risk factors. Conclusion  There are significant associations between % stage IV diagnosis and %black female population, family income, insurance status, screening practice and age.  Screening services need to be targeted in Oklahoma and Logan Counties among black, uninsured and low income females aged 40+ years.  Limitations of analysis include: - Population level data - Percentages not incidence data analysis  Future analyses to better target services could explore systematic variations of breast cancer risk with in counties.  Findings were reported in: Breast Cancer Diagnoses by Stage of Disease, 1997-2007. Technical report prepared for Susan G. Komen For the Cure, Central Oklahoma Affiliate, October, 2008. Objective  Describe risk factors associated with late stage IV breast cancer as a means to identify populations with need of earlier screening. Table 1. Multiple Robust regression model fit predicting % stage IV breast cancer diagnosis, 10 county Komen service area, 2007 VariableEstimate 95% Confidence Limits Lower Upper P value Intercept0.04690.04160.0522<.0001 % Black female0.02420.01830.0302<.0001 %White females0.00890.00140.01650.0206 %Family income below poverty level0.02650.00210.05080.0333 % No mammogram last 12 months-0.0522-0.0810-0.02340.0004 % Uninsured females (18-64 years old)0.00960.00210.01720.0123 % Females age 65 years and above0.03120.01050.05200.0032