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Variations in breast carcinoma treatment in older medicare beneficiaries

Is it black and white?

  1. Jeanne S. Mandelblatt M.D., M.P.H.1,2,†,*,
  2. Jon F. Kerner Ph.D.3,
  3. Jack Hadley Ph.D.4,
  4. Yi-Ting Hwang Ph.D.1,
  5. Lynne Eggert C.F.N.P., M.P.H.1,
  6. Lenora E. Johnson M.P.H., C.H.E.S.1,
  7. Karen Gold Ph.D.5,6,
  8. For the OPTIONS (Outcomes and Preferences for Treatment in Older Women Nationwide Study) Research Team‡

Article first published online: 17 SEP 2002

DOI: 10.1002/cncr.10825

Issue

Cancer

Cancer

Volume 95, Issue 7, pages 1401–1414, 1 October 2002

Additional Information

How to Cite

Mandelblatt, J. S., Kerner, J. F., Hadley, J., Hwang, Y.-T., Eggert, L., Johnson, L. E., Gold, K. and For the OPTIONS (Outcomes and Preferences for Treatment in Older Women Nationwide Study) Research Team (2002), Variations in breast carcinoma treatment in older medicare beneficiaries. Cancer, 95: 1401–1414. doi: 10.1002/cncr.10825

Author Information

  1. 1

    Department of Oncology, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC

  2. 2

    Department of Medicine, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC

  3. 3

    National Cancer Institute, National Institutes of Health, Washington, DC

  4. 4

    The Urban Institute, Washington, DC

  5. 5

    Department of Statistics and Biomathematics, Georgetown University Medical Center, Washington, DC

  6. 6

    Abt Associates, Bethesda, Maryland

  1. †

    Fax: 202-687-8444

  2. ‡

    The OPTIONS research tema includes: Deborah Axelrod, MD, Beth Israel Medical Center; Frederick Barr, MD, Sibley Memorial Hospital; Christine Berg, MD, Suburban Hospital Center*; Caroline Burnett, RN, ScD, Georgetown University Medical Center; Anthony Cahan, MD, Beth Israel Medical Center; Stephen Edge, MD, Roswell Park Cancer Institute; Lynne Eggert, CRNP, MPH, Georgetown University Medical Center; Karen Gold, PhD, Georgetown University Medical Center; Luther Gray, Jr., MD, Sibley Memorial Hosptial; Jackie Dunmore-Griffith, MD, Howard University Hospital; Ed Guadagnoli, PhD, Harvard Medical School; Jack Hadley, PhD, The Urban Institute*, Marilyn Halper, MPH, Beth Israel Medical Center; Nuhad Ibrahim, MD, MD Anderson Cancer Center; Claudine Isaacs, MD, Georgetown University Medical Center; Lenore E. Johnson, MPH, CHES, G. W. University School of Public Health*; Jon Kerner, PhD, National Cancer Institute*; Jack Lynch, MD, Washington Hospital Center Cancer Institute; Jeanne Mandelblatt, MD, MPH, Georgetown University Medical Center; Neal Meropol, MD, Fox Chase Cancer Center; Jean Mitchell, PhD, Georgetown University Medical Center; Bert Petersen, Jr., MD, Beth Israel Medical Center; Julia Rowland, PhD, Georgetown University Medical Center; Kevin Schulman, MD, MBA, Duke Univeristy Medical Center*; Ruby Senie, PhD, Columbia School of Public Health; Brenda Shank, MD, PhD, Doctors Medical Center; Robert Siegel, MD, George Washington University Medical Center; Rebecca Silliman, MD, MPH, PhD, Boston University Medical Center; Juliana Simmons, MD, Washington Hospital Center Cancer Institute; Theodore Tsangaris, MD, Georgetown University Medical Center; Jane Weeks, MD, Dana-Farber Cancer Institute; Rodger Winn, MD, M. D. Anderson Cancer Center. *Team members were at Georgetown University Medical Center when the study was completed. The OPTIONS national Advisory Committee included: Judith Baigis, RN, PhD, Georgetown University; Harold Freeman, MD, Harlem Hospital Center; Mary Jo Gibson, MA, American Association of Retired Persons; Bruce Hillner, MD, Medical College of Virginia; Joanne Lamphere, American Association of Retired Persons; Amy Lnager, MBA, National Alliance of Breast Cancer Organizations; Marc Lippman, MD, Georgetown University Medical Center; Monica Morrow, MD, Prentice Women's Hospital; Jeanne Petrek, MD, Memorial Slaon-Kettering Cancer Center; Rashida Muhammad, National Council of Negro Women; Natalie Davis Spingarn; David Winchester, MD, American College of Surgeons.Dr. Kerner, Dr. Hadley, and Ms. Johnson were at Georgetown Univeristy Medical Center when this work was conducted.

*Department of Oncology, Georgetown Unviersity Medical Center, 2233 Wisconsin Avenue, Suite 317, Washington, DC 20007

Publication History

  1. Issue published online: 17 SEP 2002
  2. Article first published online: 17 SEP 2002
  3. Manuscript Accepted: 2 MAY 2002
  4. Manuscript Revised: 28 JAN 2002
  5. Manuscript Received: 12 NOV 2001

Funded by

  • Agency for HealthCare Research and Qualtiy and the Federal Coordinating Committee on Breast Cancer, Office of Women's Health, DHHS. Grant Number: RO1 HS 08395
  • Department of the Army. Grant Number: DAMD 17-94-J-4212
  • National Cancer Institute. Grant Number: RO1 CA72908

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Keywords:

  • breast carcinoma;
  • elderly;
  • race;
  • Health Services Research;
  • treatment

Abstract

BACKGROUND

To evaluate associations between race and breast carcinoma treatment.

METHODS

Data 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.

RESULTS

Sixty-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).

CONCLUSIONS

Older 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

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