Racial variation in breast cancer treatment among Department of Defense beneficiaries

Authors

  • Lindsey Enewold PhD, MPH,

    Corresponding author
    1. United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC
    • United States Military Cancer Institute, Walter Reed Army Medical Center, Building 1, Suite E-111, 6900 Georgia Avenue
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  • Jing Zhou MS,

    1. United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC
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  • Katherine A. McGlynn PhD, MPH,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • William F. Anderson MD, MPH,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Craig D. Shriver MD,

    1. United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC
    2. Division of Surgical Oncology, Department of Surgery, Walter Reed Army Medical Center, Washington, DC
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  • John F. Potter MD,

    1. United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC
    2. Uniformed Services University, Bethesda, Maryland
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  • Shelia H. Zahm ScD,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Kangmin Zhu MD, PhD

    1. United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC
    2. Uniformed Services University, Bethesda, Maryland
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  • We thank the following individuals and institutes for their contributions to or support for the original data linkage project: Guy J. Gannett, David E. Radune, and Aliza Fink of ICF Macro; Wendy Funk, Julie Anne Mutersbaugh, Linda Cottrell, and Laura Hopkins of Kennel and Associates, Inc.; Kim Frazier, Elder Granger, Thomas V. Williams, and Diana Jeffery of TRICARE Management Activity; Annette Anderson, Patrice Robinson, and Chris Owner of the Armed Forces Institute of Pathology; Joseph F. Fraumeni, Jr, Robert N. Hoover, Gloria Gridley, and Joan Warren of the National Cancer Institute; Raul Parra, Anna Smith, Fiona Renalds, William Mahr, Hongyu Wu, Larry Maxwell, Miguel Buddle, and Virginia Van Horn of the United States Military Cancer Institute.

  • The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Army, Department of Defense, National Cancer Institute, or the United States Government. Nothing in the presentation implies any Federal/Department of Defense/Department of the Navy endorsement.

Abstract

BACKGROUND:

Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system.

METHODS:

The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy.

RESULTS:

There was no significant difference in surgery type, particularly when mastectomy was compared with breast-conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8-1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9-1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6-1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2-0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3-0.8).

CONCLUSIONS:

Even within an equal access health care system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted. Cancer 2012;. © 2011 American Cancer Society.

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