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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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REFERENCES

  • 1
    National Cancer Institute. SEER. Washington, DC: Department of Health and Human Services, 1998.
  • 2
    Wingo PA, Ries LA, Rosenberg HM, Miller DS, Edwards BK. Cancer incidence and mortality, 1973–1995: a report card for the U.S. Cancer. 1998; 82: 1197–1207.
    Direct Link:
  • 3
    Chevarley F, White E. Recent trends in breast cancer mortality among white and black US women. Am J Public Health. 1997; 87: 775–781.
  • 4
    American Cancer Society. Cancer and the poor: a report to the nation. Findings of regional hearings conducted by the American Cancer Society. Washington, DC: American Cancer Society, 1989.
  • 5
    Bassett M, Krieger N. Social class and black-white differences in breast cancer survival. Am J Public Health. 1986; 76: 1400–1403.
  • 6
    Lannin DR, Matthews HF, Mitchell J, Swanson MS, Swanson FH, Egan MK. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. J Am Med Assoc. 1998; 279: 1801–1807.
  • 7
    Hunter CP. Epidemiology, stage at diagnosis, and tumor biology of breast carcinoma in multiracial and multiethnic populations. Cancer. 2000; 88: 1193–1202.
    Direct Link:
  • 8
    Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996; 86: 1370–1378.
  • 9
    Krieger N. Embodying inequality: a review of concepts, measures, and methods for studying health. Int J Health Serv. 1999; 29: 295–352.
  • 10
    Dignam JJ. Difference in breast cancer prognosis among African-American and Caucasian women. CA. 2000; 50: 50–64.
  • 11
    Yood MU, Johnson CC, Blount A, et al. Race and differences in breast cancer survival in a managed care population. J Natl Cancer Inst. 1991; 91: 1487–1491.
  • 12
    El-Tamer MB, Homel P, Wait RB. Is race a poor prognostic factor in breast cancer? J Am Coll Surg. 1999; 189: 41–45.
  • 13
    McWhorter WP, Mayer WJ. Black/white differences in type of initial breast cancer treatment and implications for survival. Am J Public Health. 1987; 77: 1515–1517.
  • 14
    Allen C, Cox EB, Manton KG, Cohen HJ. Breast cancer in the elderly: current patterns of care. J Am Geriatr Soc. 1986; 34: 637–642.
  • 15
    Chu J, Diehr P, Feigl P, et al. The effect of age on the care of women with breast cancer in community hospitals. J Gerontol. 1987; 42: 185–190.
  • 16
    Howard J, Hankey BF, Greenberg RS, et al. A collaborative study of differences in the survival rates of black patients and white patients with cancer. Cancer. 1992; 69: 2349–2360.
    Direct Link:
  • 17
    Breen N, Wesley MN, Merrill RM, Johnson K. The relationship of socioeconomic status and access to minimum expected therapy among female breast cancer patients in the National Cancer Institute black/white cancer survival study. Ethn Dis. 1999; 9: 111–125.
  • 18
    Mohla S, Sampson CC, Khan T, Enterline JP, Leffall L Jr., White JE. Estrogen and progesterone receptors in breast cancer in black Americans: correlation of receptor data with tumor differentiation. Cancer. 1982; 50: 552–559.
    Direct Link:
  • 19
    Ownby HE, Frederick J, Russo J, et al. Racial differences in breast cancer patients. J Natl Cancer Inst. 1985; 75: 55–60.
  • 20
    Crowe JP Jr., Gordon NH, Hubay CA, Pearson OH, Marshall JS, McGuire WL. The interaction of estrogen receptor status and race in predicting prognosis for stage II breast cancer patients. Surgery. 1986; 100: 599–605.
  • 21
    Elledge RM, Clark GM, Chamness GC, Osborne CK. Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst. 1994; 86: 705–712.
  • 22
    Connor CS, Touijer KA, Krishnan L, Mayo MS. Local recurrence following breast conservation therapy in African-American women with invasive breast cancer. Am J Surg. 2000; 179: 22–26.
  • 23
    Trock BJ. Breast cancer in African American women: epidemiology and tumor biology. Breast Cancer Res Treat. 1996; 40: 11–24.
  • 24
    Wazer DE. The role of radiation in breast conserving therapy. Obstet Gynecol Clin North Am. 1994; 21: 681–691.
  • 25
    Warren JL, Feuer E, Potosky AL, Riley GF, Lynch CF. Use of Medicare hospital and physician data to assess breast cancer incidence. Med Care. 1999; 37: 445–456.
  • 26
    Freeman JL, Zhang D, Freeman DH, Goodwin JS. An approach to identifying incident breast cancer cases using Medicare claims data. J Clin Epidemiol. 2000; 53: 605–614.
  • 27
    NIH Consensus Conference. Treatment of early breast cancer. J Am Med Assoc 1991; 265: 391–395.
  • 28
    Stambler HV. The area resource file — a briefing book. Public Health Rep. 2000; 103: 184–186.
  • 29
    Mandelblatt J, Hadley J, Kerner J, et al. Patterns of breast carcinoma treatment in older women: patient preference, clinical, and physician influences. Cancer. 2000; 89: 561–573.
    Direct Link:
  • 30
    Du X, Freeman JL, Warren JL, Nattinger AB, Zhang D, Goodwin JS. Accuracy and completeness of Medicare claims data for surgical treatment of breast cancer. Med Care. 2000; 387: 719–727.
  • 31
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987; 40: 373–383.
  • 32
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45: 613–619.
  • 33
    Newschaffer CJ, Bush TL, Penberthy LE, Bellantoni M, Helzlsour K, Diener-West M. Does comorbid disease interact with cancer? An epidemiologic analysis of mortality in a cohort of elderly breast cancer patients. J Gerontol. 1998; 53: M372–M378.
  • 34
    Garnick DW, Luft HS, Robinson JC, Tetreault J. Appropriate measures of hospital market areas. Health Serv Res. 1987; 22: 69–89.
  • 35
    Phibbs CS, Robinson JC. A variable-radius measure of local hospital market structure. Health Serv Res. 1993; 28: 313–324.
  • 36
    Fleiss JL. Statistical methods for rates and proportions, 2nd ed. New York: John Wiley, 1981.
  • 37
    STATA reference manual. Release 5. College Station, TX: Stata Press, 1997; 2: 540–554.
  • 38
    Zhang J, Yu KF. What's a relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. J Am Med Assoc. 1998; 280: 1690–1691.
  • 39
    Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med. 1992; 326: 1147–1149.
  • 40
    Lazovich D, White E, Thomas DB, Moe RE. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. J Am Med Assoc. 1991; 266: 3433–3438.
  • 41
    Lazovich D, Solomon CC, Thomas DB, Moe RE, White E. Breast conservation therapy in the United States following the 1990 National Institutes of Health consensus development conference on the treatment of patients with early stage invasive breast carcinoma. Cancer. 1999; 86: 628–637.
    Direct Link:
  • 42
    Albain KS, Green SR, Lichter AS, et al. Influence of patient characteristics, socioeconomic factors, geography, and systemic risk on the use of breast-sparing treatment in women enrolled in adjuvant breast cancer studies: an analysis of two intergroup trials. J Clin Oncol. 1996; 14: 3009–3017.
  • 43
    Michalski TA, Nattinger AB. The influence of black race and socioeconomic status on the use of breast-conserving surgery for Medicare beneficiaries. Cancer. 1997; 79: 314–319.
    Direct Link:
  • 44
    Athas WF, Adams-Cameron M, Hunt WC, Amir-Fazli A, Key CR. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst. 2000; 92: 269–271.
  • 45
    Nattinger AB, Kneusel RT, Hoffman RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst. 2000; 93: 1344–1346.
  • 46
    Velanovich V, Yood MU, Bawle U, et al. Racial differences in the presentation of surgical management of breast cancer. Surgery. 1999; 125: 375–379.
  • 47
    Riley GF, Potosky AL, Klabunde CN, Warren JL. Stage at diagnosis and treatment patterns among older women with breast cancer: an HMO and fee-for-service comparison. J Am Med Assoc. 1999; 281: 755–756.
  • 48
    Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst. 1996; 88: 701–703.
  • 49
    Krupat E, Irish JT, Kasten LE, et al. Patient assertiveness and physician decision-making among older breast cancer patients. Soc Sci Med. 1999; 49: 449–457.
  • 50
    Elledge RM, Clark GM, Chamness GC, Osborne CK. Tumor biologic factors and breast cancer prognosis among white, Hispanic and black women in the United States. J Natl Cancer Inst. 1994; 86: 705–712.
  • 51
    Elmore JG, Moceri VM, Carter D, Larson EB. Breast carcinoma tumor characteristics in black and white women. Cancer. 1998; 83: 2509–2515.
    Direct Link:
  • 52
    Veronesi U, Luini A, Del Vecchio M,et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993; 328: 1587–1591.
  • 53
    Fisher B, Anderson S, Redmond C, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995; 333: 1456–1461.
  • 54
    Hayman JA, Fairclough DL, Harris JR, Weeks JC. Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy following conservative surgery for early-stage breast cancer. J Clin Oncol. 1997; 15: 1252–1260.
  • 55
    Morrow M, Harris JR, Schnitt SJ. Local control following breast-conserving surgery for invasive cancer: results of clinical trials. J Natl Cancer Inst. 1995; 87: 1669–1673.
  • 56
    Pierce L, Fowble B, Solin LJ, Schultz DJ, Rosser C, Goodman RL. Conservative surgery and radiation therapy in black women with early stage breast cancer: patterns of failure and analysis of outcome. Cancer. 1992; 69: 2831–2841.
    Direct Link:
  • 57
    Martelli G, DePalo G, Rossi N, et al. Long-term follow-up of elderly patients with operable breast cancer treated with surgery without axillary dissection plus adjuvant tamoxifen. Br J Cancer. 1995; 72: 1251–1255.
  • 58
    Cancer and Leukemia Group B. Protocol no. 9343: tamoxifen vs radiotherapy and tamoxifen after breast conservation in the elderly with local disease. Washington DC: Department of Health and Human Services, 1999.
  • 59
    National Cancer Institute. The NCI strategic plan to reduce health disparities. Washington, DC: National Cancer Institute, 2000.
  • 60
    Virginia Association of Health Plans. The managed care marketplace. Alexandria, VA: Virginia Association of Health Plans, 2000.
  • 61
    Mark DH. race and the limits of administrative data. J Am Med Assoc. 2001; 285: 337–338.
  • 62
    Robinson WS. Ecological correlations and the behavior of individuals. Am Sociol Rev. 1950; 15: 351–357.
  • 63
    Freeman HP. The meaning of race in science — considerations for cancer research. Cancer. 1998; 82: 219–225.
    Direct Link:
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