Women with breast cancer who live in areas where education and income levels are low are more likely to have their illness detected after it has advanced, according to a new study in the American Journal of Public Health (Vol. 92, No. 1: 64-70).

In the study, researchers said that better outreach is needed so that all women have an equal chance to be cancer-free.

Sharon Stein Merkin, at Johns Hopkins University School of Hygiene and Public Health, completed the study with colleagues at the New York City Department of Health.

The researchers looked at census and other information for nearly 38,000 New York City women diagnosed with breast cancer from 1986 to 1995. Women were grouped by levels of education and income in different zip codes, as well as by race. They were compared against one another based on the stage at which their cancer was diagnosed.

One strength of the research, the authors wrote, was the fact that the group studied was large and diverse.

"Within African-American and white populations, women living in areas with a lower percentage of high school graduates were at higher risk of presenting with advanced stage breast cancer compared to women living in areas with the highest percentage of high school graduates," said Merkin.

African-American women with cancer who were in the lowest educational and income levels had a 50% increased chance of being diagnosed with advanced breast cancer and white women had a 75% increased risk compared to women in the highest education and income groups. The risk for both groups decreased as educational levels increased.

"This study provides additional evidence of significant health disparities with regard to socioeconomic status, and suggests that we must work to overcome the obstacles that African-American and white women in low income and education areas are facing in obtaining appropriate health care," Merkin said.

She added that while her study did not examine why women had advanced cases at the time of diagnosis, she said, "The hypothesis is that living in a low education or income neighborhood may reflect reduced access to health care, preventive care, or health information."

Donella Wilson, PhD, ACS scientific program director for research and training grants, said these findings are disturbing, but not surprising. She said that the rates at which all African-American women — regardless of income and educational levels — are found to have advanced cancer is already higher than for white women.

Wilson added that outreach and education programs must take into account the barriers that women of lower socioeconomic groups face in getting adequate health care. She said, "This is more confirmation of that idea. That's why we attack poverty, but that is not the total answer."

"The study says there are identifiable racial and socioeconomic differences among women and their stage of cancer," said Wilson. "This doesn't have to happen. We like to tell physicians to treat all patients the same.

"Sometimes they won't recommend a treatment because they think the patient can't afford it, or they won't explain something if they think they can't understand it. Physicians should try to take the bias out of their diagnosis and prognosis for patients."

For their part, women need to use the prevention and early screening services they can, she said.

"If women get regular check-ups, and get what is available, their survivorship is increased," Wilson said.