Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 26, No 15S (May 20 Supplement), 2008: 535
© 2008 American Society of Clinical Oncology

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Abstract

Racial disparity trends in definitive primary therapy of early stage breast cancer

Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA

535

Background: Guidelines recommend breast-conserving surgery (BCS) with irradiation (RT) or mastectomy for definitive primary therapy of most stage I/II breast cancers. However, many women, particularly black women, do not receive RT after BCS. In a large population-based cohort, we assessed receipt of definitive locoregional therapy for early-stage breast cancer by race/ethnicity and examined whether differences decreased over time. Methods: We used Surveillance Epidemiology and End Results registry data from 1988–2004 to examine rates of definitive locoregional therapy (mastectomy or BCS with RT) for women aged 18 with stage I or II breast cancer. Multivariate logistic regression was used to assess the probability of definitive therapy. Independent variables included race/ethnicity, age, diagnosis year, marital status, region, histology subtype, grade, tumor size, hormone-receptor status, and stage. A second model included an interaction term for year by race/ethnicity to assess differences over time. Results: Among 373,937 women analyzed, 85.9% had definitive therapy. As mastectomy rates decreased (76.5% in 1988 to 37.5% in 2004, p<0.001), rates of definitive therapy also decreased (95.2% in 1988 to 79.1% in 2004, p<0.001). Unadjusted rates of definitive therapy differed by race (Table). In adjusted analyses, compared with white women, black and Hispanic women had lower odds of definitive therapy while Asians had higher odds (Table). The difference for black and white women was stable over time (p=0.76 for interaction), but differences narrowed over time for Hispanic and Asians (p<0.001 and p=0.065 for interactions). Age <45 or age 80 vs. age 45–79, low-grade tumors, and favorable histology subtypes also predicted lower odds of definitive therapy (all p<0.05). Conclusions: As BCS has increasingly substituted mastectomy, fewer women are receiving definitive breast cancer therapy, with persistent disparities evident for black and Hispanic women. Interventions to assure receipt of RT after BCS are needed to eliminate this disparity. This study was supported by a grant from Susan G. Komen for the Cure.

No significant financial relationships to disclose.

Abstract presentation from the 2008 ASCO Annual Meeting