Factors associated with breast cancer detection method in California women: an analysis of California Health Interview Survey data.

Purpose: Breast cancer mortality has significantly declined in the U.S. due in part to effective clinical screening methods. However, previous studies have found many women first detect their breast cancers through means other than their providers. Given that detection method has been shown to be an important prognostic factor, we examined the association between breast cancer detection method and various demographic and health-related factors in a representative sample of female breast cancer patients aged 40 + in California.

Methods: We analyzed data from the 2009 and 2011-2012 California Health Interview Survey. Weighted percentages of breast cancer patients by detection method were calculated. A multivariable logistic regression model was used to quantify each factor's association with the likelihood of having a patient-detected versus clinically detected breast cancer using odds ratios (ORs) and 95% confidence intervals (CIs).

Results: 36% of female breast cancer patients first detected their cancer themselves. Compared to U.S.-born women, those who had spent 40% or less of their lifetime in the U.S. were more than twice as likely to report their breast cancer being patient-detected versus clinically detected (OR = 2.27, 95% CI 1.06-4.86, p = 0.035). Rural women were also more likely to report a patient-detected breast cancer than urban women (OR = 1.51, 95% CI 1.01-2.11, p = 0.044).

Conclusions: Recent immigrants and those residing in rural areas were more likely to report self-detecting their breast cancer. Given the persistent disparities with regard to breast cancer mortality, particularly among underserved communities, strategies addressing barriers to screening uptake in these populations may be warranted.