Geographic Variation in the Use of Breast-Conserving Treatment for Breast Cancer

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

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Variations in breast carcinoma treatment in older medicare beneficiaries

Mandelblatt

Kerner

Hadley

et al. 2002

134

“…In comparison, rates of BCT in the 1980s ranged from 3.5% to 21.2% across the United States. 12 Even as recently as 1995, the use of mastectomy in the elderly was found to vary by 4.7-fold across hospital referral regions, from 0.91 per 1000…”

Section: Discussionmentioning

confidence: 99%

“…However, we did find markedly increased rates of BCT in the elderly using the same population and methods as previous studies. 10,12 Therefore, stage should not be a significant confounder. The association between socioeconomic status and BCT use could be confounded by disease stage.…”

Section: Limitationsmentioning

confidence: 99%

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

Alderman

Bynum

Sutherland

et al. 2010

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.

“…Two randomized trials published in the mid-1980s demonstrated that breast-conserving surgery (hereinafter referred to as lumpectomy) plus whole-breast RT provided equivalent survival benefits while improving the cosmetic effects and quality of life for the patient. 1,2 Nattinger et al 3 and Farrow et al 4 demonstrated that, within a few years, the use of lumpectomy among U.S. women increased rapidly. With a higher usage of screening mammography and with a downward shift in the stage distribution of newly diagnosed breast carcinoma cases, the choice of the more limited surgical approach has increased even further.…”

mentioning

confidence: 99%

Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma

Zablotska

Neugut

2003

130

BACKGROUNDPrior studies have demonstrated that women who receive adjuvant radiation therapy (RT) after mastectomy for breast carcinoma have an increased risk of a second primary lung carcinoma after 10 years, but, to the authors' knowledge, the risk associated with adjuvant RT after breast‐conserving surgery (lumpectomy) has yet to be determined. The purpose of the current study was to confirm and extend earlier findings of the effects of postmastectomy RT on second primary lung carcinoma and to investigate the impact of postlumpectomy RT on second primary lung carcinoma in the same population and to compare the results.METHODSThe authors used data from the population‐based Surveillance, Epidemiology, and End Results (SEER) program of the U.S. National Cancer Institute, encompassing approximately 10% of the U.S. population, from 1973 to 1998. Of the women with nonmetastatic invasive breast carcinoma, 194,981 had been treated with mastectomy and 65,560 were treated with lumpectomy. Cox regression analysis was used to estimate the relative risk (RR) of a second primary lung carcinoma among women treated with RT compared with those who received surgery alone as a function of time interval since treatment and laterality for both types of surgery.RESULTSAlthough no statistically significant elevation in risk for second primary lung carcinoma prior to 10 years was observed, the authors estimated a RR of 2.06 (95% confidence interval [95% CI], 1.53–2.78) and 2.09 (95% CI, 1.50–2.90) for ipsilateral lung carcinoma at 10–14 years and 15+ years after postmastectomy RT, respectively, whereas no increased risk was observed for the contralateral lung. The excess risk of ipsilateral lung carcinoma after postmastectomy RT was found for all three major histologic subtypes of lung carcinoma (adenocarcinoma, squamous cell carcinoma, and small cell carcinoma). No increased risk of lung carcinoma was observed at 10–14 years after postlumpectomy RT for either lung.CONCLUSIONSPostmastectomy RT was found to provide a moderate increase in risk for ipsilateral lung carcinoma starting 10 years after exposure; this increased risk is reported to persist to at least 20 years. Postlumpectomy RT does not appear to incur an increased risk. These findings should be reassuring to women treated with either type of RT, but the excess risk in the postmastectomy group should be considered in the choice between treatment options. Cancer 2003;97:1404–11. © 2003 American Cancer Society.DOI 10.1002/cncr.11214