Integrating clinical and social determinants to predict breast cancer stage at diagnosis.

Abstract

547 Background: Breast cancer outcomes are influenced by both clinical and social determinants of health, contributing to persistent disparities in diagnosis and prognosis. Identifying factors associated with disease stage at diagnosis may inform targeted interventions to improve outcomes and advance health equity. Methods: A cross-sectional study was conducted among 111 adult breast cancer survivors (18–89 years) recruited from the OSF HealthCare START Survivorship Clinic. Participants were identified through the EMR, consented via the OSF Community Connect platform, and completed surveys assessing sociodemographic characteristics and survivorship-related factors. Clinical data, including cancer stage and receptor status, were extracted from the EMR. HER2-positive and triple-negative breast cancer cases were excluded. Associations between participant characteristics and pathological stage were assessed using chi-square tests, followed by Bayesian ordinal logistic regression to evaluate the independent effects of age at diagnosis and rural residence on cancer stage. Results: The mean age at breast cancer diagnosis was 62 (SD ± 12.09). Among the 111 participants, 56.5% were diagnosed with Stage I disease, 39.1% resided in rural areas, and 60.9% in urban areas. No significant associations were observed between sociodemographic characteristics and pathological stage using bivariate analyses. In Bayesian ordinal logistic regression, older age at diagnosis was independently associated with a lower likelihood of being diagnosed with a more advanced cancer stage (OR=0.97 per year; 95% credible interval: 0.94–0.99). Rural residence was not associated with cancer stage (OR=1.04; 95% credible interval: 0.48–2.15), suggesting no meaningful difference in stage at diagnosis between rural and urban survivors. Conclusions: Older age at diagnosis was associated with lower odds of advanced-stage breast cancer, whereas rural residence was not. These findings underscore the importance of integrating clinical and social determinants of health to improve risk stratification and inform equitable, data-driven breast cancer screening and survivorship interventions.