Variations in breast carcinoma treatment in older medicare beneficiaries
Is it black and white?
Version of Record online: 17 SEP 2002
Copyright © 2002 American Cancer Society
Volume 95, Issue 7, pages 1401–1414, 1 October 2002
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
- Issue online: 17 SEP 2002
- Version of Record online: 17 SEP 2002
- Manuscript Accepted: 2 MAY 2002
- Manuscript Revised: 28 JAN 2002
- Manuscript Received: 12 NOV 2001
- 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
- breast carcinoma;
- Health Services Research;
To evaluate associations between race and breast carcinoma treatment.
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.
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).
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.