Disparities in late-stage cancer diagnosis across a multi-site academic health system

In a retrospective cohort study reported in BMC Cancer, 17.6% of 26,698 adults diagnosed with breast, colorectal, or lung and bronchus cancer across six University of California academic medical centers had stage III or IV disease. The study found that late-stage diagnosis was associated with cancer type, insurance coverage, and neighborhood deprivation, although the association with neighborhood deprivation was observed only for breast cancer.

Researchers reviewed adults diagnosed with one of the three cancer types from 2015 through 2025. Late-stage disease was defined using structured TNM data corresponding to AJCC stage III or IV. Multivariable logistic regression evaluated associations with patient characteristics, insurance coverage, comorbidity burden, and neighborhood context. Neighborhood context was measured with the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Healthy Places Index (HPI). The analysis also tested whether the ADI association differed by cancer type.

Compared with breast cancer, the adjusted odds of late-stage diagnosis were higher for colorectal cancer (OR, 8.40; 95% CI, 7.62–9.27) and lung and bronchus cancer (OR, 14.24; 95% CI, 12.84–15.78). Patients in moderately deprived neighborhoods had 10% higher adjusted odds of late-stage diagnosis than those in the least deprived ADI tertile (OR, 1.10; 95% CI, 1.01–1.20), while those in highly deprived neighborhoods had 21% higher odds (OR, 1.21; 95% CI, 1.10–1.33). Medicaid coverage and other or unknown insurance coverage were also associated with higher odds of late-stage disease. SVI was not associated with stage, and the HPI association did not reach statistical significance.

The ADI association varied by cancer type (P = .0001) and was confined to breast cancer in this analysis. Among breast cancer patients, high neighborhood deprivation was associated with 55% higher odds of late-stage diagnosis (OR, 1.55; 95% CI, 1.31–1.85). The authors concluded that health systems may use neighborhood measures and insurance information to identify populations that could benefit from targeted screening outreach, navigation, and interventions intended to reduce barriers to early cancer detection. As a retrospective observational study, the findings report associations rather than causal effects, and the results apply to the selected adult cancer population and six-center health system studied.

Subject of Research: Associations between patient, insurance and neighborhood factors and late-stage diagnosis in breast, colorectal and lung cancer

Article Title: Disparities in late-stage cancer diagnosis across a multi-site academic health system

Article References: Tran, V. H., Rajan, S. M., Ochoa Dominguez, C. Y., Demb, J., Parada, H., Martinez, E., McDaniels, C., Crespo, N., Schiaffino, M. K., Mehtsun, W., Murphy, J., Rose, B., & Banegas, M. P. (2026). Disparities in late-stage cancer diagnosis across a multi-site academic health system. BMC Cancer. https://doi.org/10.1186/s12885-026-17117-5

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17117-5

Keywords: late-stage cancer diagnosis, breast cancer, colorectal cancer, lung cancer, cancer stage, neighborhood deprivation, insurance coverage, health disparities, retrospective cohort study, Disparities, late-stage, cancer