Underutilization of Breast-Conserving Surgery and Radiation Therapy Among Women With Stage I or II Breast Cancer

BACKGROUND: Breast-conserving therapy (BCT) has emerged as the preferred treatment for most women with early stage breast cancer. However, there is concern for underuse in the elderly, with previously documented low rates of BCT and large variations in practice patterns. The authors' purpose was to examine patterns and correlates of BCT for breast cancer in the elderly US population. METHODS: The primary outcome was receipt of BCT. The 2003 to 2004 Medicare inpatient, outpatient, and carrier files were used to identify incident breast cancer patients and the American Medical Association to ascertain surgeon information. The primary independent variables were US state where treatment was performed along with patient and surgeon sociodemographic information. Multivariate logistic regression was used for the analyses.

Section: Discussioncontrasting

confidence: 71%

Section: Original Articlementioning

confidence: 59%

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment of breast cancer among the elderly in the United States

Alderman

Bynum

Sutherland

et al. 2010

“…These data extend findings from previous research demonstrating that black women may receive less aggressive treatment for their breast carcinomas than whites 39 -43 and that racial differences in treatment often persist after control for sociodemographic factors. 39,40,43 Our findings also suggest that black women may have different experiences in receiving care for their breast carcinoma than whites. This idea is supported by the result that blacks perceived more racism and ageism in the health care system than whites.…”

Section: Discussionmentioning

confidence: 56%

Variations in breast carcinoma treatment in older medicare beneficiaries

Mandelblatt

Kerner

Hadley

et al. 2002

134

BACKGROUNDTo evaluate associations between race and breast carcinoma treatment.METHODSData from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3–4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources.RESULTSSixty‐seven percent of women received a mastectomy and 33% received breast‐conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01–2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race‐stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25–5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06).CONCLUSIONSOlder black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within‐stage race mortality disparities. Cancer 2002;95:1401–14. © 2002 American Cancer Society.DOI 10.1002/cncr.10825

“…12 Results of studies on racial differences in the use of BCS are inconsistent. [13][14][15] In addition, a significant reduction in the use of irradiation following lumpectomy has been shown in older age groups, 12,16,17 but there are relatively limited reports of data regarding racial variations in radiation treatment. Therefore, the purpose of this study was to analyze racial differences in treatment (use of BCS and radiation therapy) for early-stage breast carcinoma and the resulting effects on survival.…”

mentioning

confidence: 99%

Racial differences in treatment and survival from early‐stage breast carcinoma

Joslyn

2002

108

BACKGROUNDAfrican‐American women have a significantly worse prognosis from breast carcinoma compared with white women, even when the stage at diagnosis is equivalent. The purpose of this study was to analyze racial differences in the treatment (use of breast‐conserving surgery and radiation therapy) of women with early‐stage breast carcinoma and the resulting effects on survival rates.METHODSSubjects included 10,073 African‐American and 123,127 white women diagnosed with Stage I, IIA, or IIB breast carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results program between 1988 and 1998. Comparisons were made by race with treatment, age, hormone receptor status, and stage at the time of diagnosis. Survival analyses were conducted to compare risk of death for African‐American and white women while controlling for age, stage, and hormone receptor status.RESULTSAmong women diagnosed with early‐stage breast carcinoma who receive breast‐conserving surgery, African‐American women were significantly less likely to receive follow‐up radiation therapy in every 10‐year age group except in the older than 85 age group. Whether treatment was equivalent or suboptimal, survival for African‐American women with early‐stage breast carcinoma was significantly worse. However, when treatment was equivalent, the effects of racial differences on survival were significantly less compared with survival associated with suboptimal treatment.CONCLUSIONSSignificant racial differences exist in the treatment of women with early‐stage breast carcinoma. Public health efforts to eliminate suboptimal treatment would reduce, but not eliminate, racial disparity in survival. Cancer 2002;95:1759–66. © 2002 American Cancer Society.DOI 10.1002/cncr.10827