Persistent Differences in Sociodemographic Determinants of Breast Conserving Treatment Despite Overall Increased Adoption

Gilligan, Mary Ann; Kneusel, Ronald T.; Hoffmann, Raymond G.; Greer, Ann; Nattinger, Ann B.

doi:10.1097/00005650-200203000-00002

Cited by 95 publications

(88 citation statements)

References 34 publications

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“…Furthermore, it is difficult for patients with low incomes to afford the expense of radiotherapy following breast-conserving surgery. In addition, these patients usually live in areas in which it may be difficult to obtain radiotherapy (Gilligan et al, 2002). Our research did not find any influence of education level on surgical treatment options, which may reflect the small numbers of breast cancer cases in this study or the large number of patients with unidentified education backgrounds that were included.…”

Section: Discussionmentioning

confidence: 63%

“…This may be because patients with low-income and high-stress occupations delay in presenting at clinic and are therefore more likely to present with advanced stages of breast tumors (Grunfeld et al, 2002;Bish et al, 2005), thus losing the opportunity for sentinel lymph node biopsy and breast-conserving surgery. In contrast, patients in higher income occupations are more likely to accept new concepts and technologies, thus leading to their increased acceptance of sentinel lymph node biopsy and breast-conserving surgery (Gilligan et al, 2002;Keating et al, 2003). Furthermore, it is difficult for patients with low incomes to afford the expense of radiotherapy following breast-conserving surgery.…”

Section: Discussionmentioning

confidence: 99%

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Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Wang

Li²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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The impact of income and education level on the clinical and pathologic characteristics, implementation of clinical breast examination (CBE), and treatment patterns of a small population of Chinese female breast cancer patients was studeied in order to provide a theoretical basis and statistical reference for further nationwide research. We included 484 pathologically confirmed female primary breast cancer inpatients of the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from February 2003 to January 2004. All cases were reviewed and relevant information was collected using a designed case report form (CRF). Chisquare tests, rank-sum tests, and Fisher's exact tests were used in the analysis. Our analysis showed that: (1) women in different occupation groups had significant differences in tumor size, pre-operative mammography, surgical options, post-operative estrogen receptor (ER), progestin receptor (PR) and human epidermal growth factor receptor 2 (Her2) status, and post-operative radiotherapy and chemotherapy (P < 0.05); and (2) women with different education levels had statistically significant differences in tumor size, post-operative ER, PR and Her2 status, and post-operative chemotherapy, radiotherapy, and endocrine therapy (P < 0.05). In Xi'an, China, women in low-income occupations or with low education levels are more likely to have advanced tumor stages at presentation, lower implementation rate of clinical breast examination, and less treatment.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Wang

Li²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…First, we developed and validated an algorithm to identify incident breast cancer cases [9] and validated the endpoint analyzed with a random sample of medical records. Second, the study is population-based and minimize selection bias of predictors of cancer treatment such as geographic, regional, urban vs. rural location, and socioeconomic status [29]. Third, we were able to adjust for several important covariates, both at the patient and healthcare system levels.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy

Rosato

Sacerdote

Pagano

et al. 2008

Breast Cancer Res Treat

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Administrative data may provide valuable information for monitoring the quality of care at population level and offer an efficient way of gathering data on individual patterns of care, and also to shed light on inequalities in access to appropriate medical care. The aim of the study was to investigate the role of patient and hospital characteristics in the initial treatment of early breast cancer using administrative data. Incident breast cancer patients were identified from hospital discharge records and linked to the radiotherapy outpatient database during 2000-2004 in the Piedmont region of Northwestern Italy. Women treated with breast-conserving surgery followed by radiotherapy (BCS ? RT) were compared to those treated with BCS without radiotherapy (BCS w/o RT) or mastectomy using multinomial logistic regression models. Out of 16,022 incident cases, 46.2% received BCS ? RT, 20.3% received BCS w/o RT, and 33.5% received a mastectomy. Compared to BCS ? RT, the factors associated with BCS w/o RT were: increased age (OR = 1.54; 95% CI = 1.29-1.85, for ages 70-79 vs. \50), being unmarried (1.24; 1.13-1.36), presence of co-morbidities (1.32; 1.10-1.58), being treated at hospitals with low surgical volume (1.31; 1.07-1.60 for hospitals with less than 50 vs. C150 interventions/year), and living far from radiotherapy facilities (1.75; 1.39-2.20 for those at a distance of [45 min). These same factors were also associated with mastectomy. During the 5-year period observed, there was a trend of reduced probability of receiving a mastectomy (0.70; 0.56-0.88 for 2004 vs. 2000). The presence or absence of nodal involvement was positively associated with mastectomy (2.28; 1.83-2.85) and negatively associated with BCS w/o RT (0.65; 0.56-0.76). After adjustment for potential confounders, education level did not show any association with the type of treatment. Social and geographical factors, in addition to hospital specialization, should be considered to reduce inappropriateness of care for breast cancer.

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“…10 The most recent study from 1996 found that less than half of elderly breast cancer patients undergo BCT with or without radiation. 11 Reasons for the underuse of BCT in the elderly are unclear. Low use of BCT has been correlated with rural healthcare settings, [11][12][13][14] treatment received in the southern and central United States, 12,15 and low patient socioeconomic status.…”

mentioning

confidence: 99%

“…11 Reasons for the underuse of BCT in the elderly are unclear. Low use of BCT has been correlated with rural healthcare settings, [11][12][13][14] treatment received in the southern and central United States, 12,15 and low patient socioeconomic status. 11,16 The influence of these nonclinical factors on the surgical treatment of breast cancer suggests that informed patient choice may not be fully optimized in this population.…”

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confidence: 99%

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

Alderman

Bynum

Sutherland

et al. 2010

Cancer

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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.

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Persistent Differences in Sociodemographic Determinants of Breast Conserving Treatment Despite Overall Increased Adoption

Abstract: Sociodemographic differences in BCT use have persisted over time. The increased overall adoption of BCT has not led to consistency in use of this treatment.

Cited by 95 publications

References 34 publications

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Socio-economic Factors Influencing Tumor Presentation and Treatment Options in Chinese Breast Cancer Patients

Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy

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

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