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Differences in the quality of breast cancer care among vulnerable populations

  1. David A. Haggstrom M.D.1,†,*,
  2. Chris Quale Ph.D.2,
  3. Rebecca Smith-Bindman M.D.2,3

Article first published online: 6 OCT 2005

DOI: 10.1002/cncr.21443

Issue

Cancer

Cancer

Volume 104, Issue 11, pages 2347–2358, 1 December 2005

Additional Information

How to Cite

Haggstrom, D. A., Quale, C. and Smith-Bindman, R. (2005), Differences in the quality of breast cancer care among vulnerable populations. Cancer, 104: 2347–2358. doi: 10.1002/cncr.21443

Author Information

  1. 1

    Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

  2. 2

    Department of Radiology, University of California, San Francisco, California

  3. 3

    Department of Epidemiology and Biostatistics, University of California, San Francisco, California

  1. †

    Fax: (301) 435–3710

*Executive Plaza North, Room 4009C, 6130 Executive Blvd, Bethesda, MD, 20892–7344

Publication History

  1. Issue published online: 18 NOV 2005
  2. Article first published online: 6 OCT 2005
  3. Manuscript Accepted: 28 JUN 2005
  4. Manuscript Revised: 1 JUN 2005
  5. Manuscript Received: 26 APR 2005

Funded by

  • University of California, San Francisco, Division of General Internal Medicine, General Internal Medicine Clinical Research Fellowship
  • Health Resources and Services Administration Faculty Development Grant. Grant Number: 1D14 HP001 78–01
  • California Breast Cancer Research Program. Grant Number: 9PB-0205
  • Department of Defense. Grant Number: DAMD17–99–1-9112
  • National Institutes of Health (NIH). Grant Number: CA86032

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Keywords:

  • breast cancer;
  • therapy;
  • African Americans;
  • Hispanic Americans;
  • Asian Americans;
  • physician's practice patterns;
  • women's health

Abstract

BACKGROUND

It is unknown whether differences in the quality of breast cancer care among women from racial and ethnic minority groups, the elderly, and rural areas have changed over time across the continuum of care.

METHODS

The linked Surveillance, Epidemiology, and End Results-Medicare database identified 22,701 women ages 66–79 years diagnosed with early stage breast cancer from 1992–1999. Multiple breast cancer processes of care were measured, including breast-conserving surgery, radiation therapy, documentation of estrogen receptor status, surveillance mammography, and a combined measure of “adequate care”.

RESULTS

African-American and Hispanic women were significantly less likely to receive adequate care than White women in unadjusted comparisons (54.7% and 58.0% vs. 68.4% for African-American and Hispanic vs. White women) and adjusted comparisons (adjusted odds ratio [AOR] 0.67; 95% confidence interval [95% CI] 0.59–0.76, and AOR 0.77; 95% CI 0.66–0.90 for African-American and Hispanic women, respectively). The proportion of Asian/Pacific Islander women receiving adequate care was similar to White women. When considering only women diagnosed with breast cancer from 1997–1999, African-American women remained less likely than White women to receive adequate care (AOR 0.63; 95% CI 0.50–0.79). Women ages 75–79 years were less likely to receive adequate care compared with women ages 66–69 years (AOR 0.74; 95% CI 0.69–0.80), and women from rural (vs. metropolitan) areas were less likely to receive adequate care (AOR 0.81; 95% CI 0.73–0.89).

CONCLUSIONS

The quality of breast cancer care is lower among vulnerable populations across the continuum of care, and many of these differences have not improved in more recent years. Cancer 2005. © 2005 American Cancer Society.

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