Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Derek Chapman

Second Advisor

Carol Bazzichi


Introduction: Among women, breast cancer is the most prevalent cancer and the second leading cause of cancer death. Although technology advances have improved survival rates for breast cancer overall, improvements have not been universally experienced by all socioeconomic and racial groups. Known determinants of breast cancer care disparities include socioeconomic status, race, age, and social support. As a part of the Breast and Cervical Cancer Mortality Prevention Act of 1990 and with the help of CDC funding, the Virginia Breast and Cervical Cancer Early Detection Program (BCCEDP) or Every Woman’s Life (EWL) was created. EWL provides breast cancer screening to female VA residents between the ages of 18 and 64 who lack health insurance and fall at or below 200% of the Federal Poverty Level. Objective: The purpose of this study is to determine if delays in the diagnosis and treatment of breast cancer, within the VDH program EWL, differs based on sociodemographic characteristics and/ or regional location. Methods: From its inception to July 2008, 705 women received a breast cancer diagnosis through the EWL program. For these 705 cases prevalence and crude odds ratios were calculated for both diagnosis and treatment delays for all of the demographic variables along with 95% confidence intervals. Adjusted odds ratios were calculated for sociodemographic variables against screening to diagnosis delays and diagnosis to treatment disparities along with 95% confidence intervals. Results: According to the crude odds ratios more women who fall into the other category of race experienced diagnosis delays (OR=2.28 [1.11, 4.67]), but they were more likely to receive treatment in a timely manner (OR=0.29 [0.11, 0.79]). Women living alone were also more likely to experience diagnosis delays (OR=1.49 [1.10, 3.02]). Hispanic women were more likely to receive treatment in a more timely manner than non-Hispanic women (OR=0.21 [0.05, 0.81]). Also, women being treated in any other region than northern VA were more likely to experience treatment delays. However, according to the adjusted odds ratios, the only significant timing delay was the one experienced more often by women in the other race category. Conclusion: The research indicates known indicators of disparities within cancer care as socioeconomic status, race, ethnicity, age, and social support. The findings of this study indicate that the only significant indicator of disparity within the Every Women’s Life program is race. Although, African-American women were just as likely to receive timely diagnosis and treatment as white women in the program, it was the combined groups of Asian, American Indian, and other women that were more likely to experience diagnosis, but not treatment, delays. The fact that no other significant indicators of disparities were found within EWL indicates a success of the program, as EWL is targeting those women that would have otherwise been missed by the system.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2009

Included in

Epidemiology Commons