Variations in breast carcinoma treatment in older medicare beneficiaries

Abstract

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

Breast Cancer Racial Disparities: Unanswered Questions

“…When blacks do undergo breast-conserving surgery, they are less likely to receive radiation than whites. In this study, the odds of radiation omission were more pronounced in blacks who lived in high-poverty areas or in areas farther from cancer centers (34). Interestingly, these factors did not affect radiation use among whites.…”

Urban/Rural Residence Moderates Effect of Race on Receipt of Surgery in Patients with Nonmetastatic Breast Cancer: A Report from the South Carolina Central Cancer Registry

“…Finally we cannot rule out the possibility that racial bias on the part of physicians, or perceived racism on the part of patients (as described in a previous study of Medicare recipients with breast cancer), were involved. 27 To our knowledge, this is the first study to report the interaction between urban/rural residence, race, and underuse of surgical resection in patients with nonmetastatic breast cancer. Several studies have reported an association between rural residence and underuse of BCT among women with invasive breast cancer.…”

Omission of radiation therapy after breast‐conserving surgery in the United States

“…On the contrary, the omission of RT after BCS increased significantly for women who had increased cancer stage, young age, high-grade tumors, large tumors, lymph nodepositive or not tested status, African American or Hispanic race, and negative or unknown ER status. Other investigators have reported that the omission of RT after BCS is associated with older age, 17,18 African American race, [17][18][19] Hispanic race, 19 Medicaid insurance coverage, 19 widowed or never married status, 20 patient comorbidities, 18 inner quadrant tumor location, 21 lymph node metastases, 21 negative or unknown ER status, 22 and larger tumor size. 23 We observed considerable variation in the use of RT after BCS across geographic areas.…”