Disparities in Breast Cancer Treatment among American Indian, Hispanic and Non-Hispanic White Women Enrolled in Medicare

Abstract

Because racial/ethnic disparities in breast cancer survival have persisted, we investigated differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White (NHW) women. Surveillance, Epidemiology and End Results data linked to Medicare claims in New Mexico and Arizona (1987-1997) among enrollees aged 65 and older were used to identify treatment, treatment interval, and mortality risk associated with delays in care. We identified 2,031 women (67 American Indian, 333 Hispanic and 1,631 NHW women with time to treatment information. Treatment intervals from diagnosis to surgery (all stages, 18 versus 4 days, p.

Comparison of breast and cervical cancer screening utilization among rural and urban Hispanic and American Indian women in the Southwestern United States

“…However, the incidence of breast cancer among NHW women declined by 3 % during that same time period [7]. National studies have estimated the 5-year survival rate for breast cancer was lower among AI women compared with NHW women and a higher proportion of AI women did not receive their first cancer-directed surgery within the first 6 months following diagnosis [8,9]. In addition, although the incidence of breast cancer among AI women in the Southwestern region of the US is significantly lower than that of other AI women around the US, it is still the leading cancer among Southwestern AI women [7,10,11].…”

“…AI women have among the lowest breast and cervical cancer screening rates in the US and this particularly pronounced among AI women in the Southwestern US [20,22,23]. Thus, the benefit of early detection of breast and cervical cancer has been much less apparent among Hispanic and AI populations [8,24].…”

Influence of birthplace on breast cancer diagnosis and treatment for Hispanic women

“…Foreign-born Hispanic women in the United States have a lower probability of being diagnosed at earlier stages of breast cancer and, for women with early-stage disease, of receiving radiation following BCS compared to US-born Hispanics and whites. Identifying factors mediating these disparities may help in developing culturally and linguistically appropriate interventions and improving outcomes.Keywords Breast cancer Á Early diagnosis Á Hispanic Americans Á Immigrants Á Surgery Racial and ethnic disparities in breast cancer diagnosis, treatment, and outcomes have been reported [1][2][3][4]. Hispanic women in the United States are diagnosed with breast cancer at more advanced stages [5][6][7], initiate treatment later [5,8] and have a lower 5-year survival rate [9-11] than non-Hispanic white women.…”

Cancer Surgery Among American Indians

“…5 Indeed, the most recent data from the American Cancer Society indicate that AI and Alaskan Native women are the only demographic groups not to benefit from a remarkable decline in cancer death rates during the past decade. Oncologic resection represents a critical component of therapy for most solid malignant neoplasms.…”

“…Ethnic disparities in the delivery of cancer care exist at multiple points along the pathway from entry into the health care system to definitive management (Figure 2). American Indians receive cancer diagnoses when the disease is at more advanced stages, 3 have significant delays from diagnosis to treatment, 5 and are less likely to receive appropriate therapy. 4 However, the longterm survival deficit has been reported to persist even after controlling for tumor grade and stage at diagnosis and the type of treatment delivered.…”