Racial disparities in the use of radiotherapy after breast-conserving surgery: A national Medicare study

Authors

  • Grace L. Smith MD, PhD, MPH,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Ya-Chen T. Shih PhD,

    1. Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Ying Xu MD, MS,

    1. Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Sharon H. Giordano MD, MPH,

    1. Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Benjamin D. Smith MD,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    2. Radiation Oncology Flight, Wilford Hall Medical Center, Lackland Air Force Base, Texas
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  • George H. Perkins MD,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Welela Tereffe MD,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Wendy A. Woodward MD, PhD,

    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Thomas A. Buchholz MD

    Corresponding author
    1. Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 97, Houston, TX 77030===

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  • Presented in part at the American Society of Clinical Oncology (ASCO) 2008 Breast Cancer Symposium, Washington, DC, September 5-7, 2008.

Abstract

BACKGROUND:

In prior studies, the use of standard breast cancer treatments has varied by race, but previous analyses were not nationally representative. Therefore, in a comprehensive, national cohort of Medicare patients, racial disparities in the use of radiotherapy (RT) after breast-conserving surgery (BCS) for invasive breast cancer were quantified.

METHODS:

A national Medicare database was used to identify all beneficiaries (age >65 years) treated with BCS for incident invasive breast cancer in 2003. Claims codes identified RT use, and Medicare demographic data indicated race. Logistic regression modeled RT use in white, black, and other-race patients, adjusted for demographic, clinical, and socioeconomic covariates.

RESULTS:

Of 34,080 women, 91% were white, 6% were black, and 3% were another race. The mean age of the patients was 76 ± 7 years. Approximately 74% of whites, 65% of blacks, and 66% of other-race patients received RT (P < .001). After covariate adjustment, whites were found to be significantly more likely to receive RT than blacks (odds ratio, 1.48; 95% confidence interval, 1.34-1.63 [P < .001]). Disparities between white and black patients varied by geographic region, with blacks in areas of the northeastern and southern United States demonstrating the lowest rates of RT use (57% in these regions). In patients age <70 years, racial disparities persisted. Specifically, 83% of whites, 73% of blacks, and 78% of other races in this younger group received RT (P < .001).

CONCLUSIONS:

In this comprehensive national sample of older breast cancer patients, substantial racial disparities were identified in RT use after BCS across much of the United States. Efforts to improve breast cancer care require overcoming these disparities, which exist on a national scale. Cancer 2010. © 2009 American Cancer Society.

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