Racial variation in breast cancer treatment among Department of Defense beneficiaries

Abstract

BACKGROUND Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in healthcare access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System all beneficiaries have equal access to healthcare. The aim of this study was to determine if breast cancer treatment varied between white and black female breast cancer patients in the DoD system. METHODS The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2,308 white and 391 black female beneficiaries diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy and hormonal therapy. RESULTS There was no significant difference in surgery type, particularly when mastectomy was compared to breast conserving surgery plus radiation (blacks vs. whites: OR=1.1; 95% CI=0.8–1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR=1.2; 95% CI=0.9–1.8) and hormonal therapy (OR=1.0; 95% CI=0.7–1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR=0.4; 95% CI=0.2–0.7) and hormonal therapy (OR=0.5; 95% CI=0.3–0.8). CONCLUSION Even within an equal access healthcare system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted.

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

“…Sponsor military rank was classified as officer, enlisted junior (lowest four ranks in any branch of service), senior enlisted (noncommissioned officers), and other (warrant officers and cadets). In line with prior research using TRICARE data, sponsor military rank was considered a proxy for socioeconomic status in this analysis with individuals in the enlisted junior category maintained to be representative of those in lower socioeconomic circumstances [6,16,18,22]. The type of surgical intervention was determined using ICD-9 procedure codes and defined as discectomy, decompression, posterolateral fusion, and interbody fusion using a previously published algorithm [17].…”

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

“…The linked database from the Department of Defense (DoD)’s Central Cancer Registry (CCR) and the MHS Data Repository (MDR) was used in this study and described previously (39, 40). The CCR contains information on cancer patients diagnosed or treated at military treatment facilities (MTFs).…”

Demographic risk factors impacting timely radiation therapy completion after breast conserving surgery

“…Despite the overall improving survival for women with breast cancer in the United States, survival rates for Black women have not improved at the same rate as white women [13]. Additionally, studies have demonstrated that access to adjuvant therapy alone is insufficient to account for the persistent racial disparities in outcomes [14][15][16][17].…”