Research

The geographic distribution of breast cancer incidence in Massachusetts 1988 to 1997, adjusted for covariates

T Joseph Sheehan¹ , Laurie M DeChello¹ , Martin Kulldorff² , David I Gregorio¹ , Susan Gershman³ and Mary Mroszczyk³

¹Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, USA 06030-6325

²Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6^th Floor, Boston, MA, USA 02215

³Massachusetts Cancer Registry, Massachusetts Department of Public Health, 2 Boylston St, 6^th Floor, Boston, MA, USA 02116

author email corresponding author email

International Journal of Health Geographics 2004, 3:17doi:10.1186/1476-072X-3-17

Published:	3 August 2004

Abstract

Background

The aims of this study were to determine whether observed geographic variations in breast cancer incidence are random or statistically significant, whether statistically significant excesses are temporary or time-persistent, and whether they can be explained by covariates such as socioeconomic status (SES) or urban/rural status?

Results

A purely spatial analysis found fourteen geographic areas that deviated significantly from randomness: ten with higher incidence rates than expected, four lower than expected. After covariate adjustment, three of the ten high areas remained statistically significant and one new high area emerged. The space-time analysis identified eleven geographic areas as statistically significant, seven high and four low. After covariate adjustment, four of the seven high areas remained statistically significant and a fifth high area also identified in the purely spatial analysis emerged.

Conclusions

These analyses identify geographic areas with invasive breast cancer incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the epidemiologist and has the potential of monitoring time trends for cancer control activities.