Racial/Ethnic Disparities in Knowledge about Risks and Benefits of Breast Cancer Treatment: Does It Matter Where You Go?

Authors

  • Sarah T. Hawley,

    1. Division of General Medicine, University of Michigan Health System and Ann Arbor VA Medical Center, 300 N. Ingalls Room 7C27, Ann Arbor, MI,
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    • Address correspondence to Sarah T. Hawley, Ph.D., M.P.H., Division of General Medicine, University of Michigan Health System and Ann Arbor VA Medical Center, 300 N. Ingalls Room 7C27, Ann Arbor, MI; e-mail: sarahawl@umich.edu. Angela Fagerlin, Ph.D., and Steven J. Katz, M.D., M.P.H., are with the Division of General Medicine, University of Michigan Health System and Ann Arbor VA Medical Center, Ann Arbor, MI. Dr. Fagerlin is also with the Center for Behavioral and Decision Sciences in Medicine. Nancy K. Janz, Ph.D., is with the Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI.

  • Angela Fagerlin,

    1. Division of General Medicine, University of Michigan Health System and Ann Arbor VA Medical Center, 300 N. Ingalls Room 7C27, Ann Arbor, MI,
    2. Center for Behavioral and Decision Sciences in Medicine,
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  • Nancy K. Janz,

    1. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
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  • Steven J. Katz

    1. Division of General Medicine, University of Michigan Health System and Ann Arbor VA Medical Center, 300 N. Ingalls Room 7C27, Ann Arbor, MI,
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Abstract

Objective. To evaluate the association between provider characteristics and treatment location and racial/ethnic minority patients' knowledge of breast cancer treatment risks and benefits.

Data Sources/Data Collection. Survey responses and clinical data from breast cancer patients of Detroit and Los Angeles SEER registries were merged with surgeon survey responses (N=1,132 patients, 277 surgeons).

Study Design. Cross-sectional survey. Multivariable regression was used to identify associations between patient, surgeon, and treatment setting factors and accurate knowledge of the survival benefit and recurrence risk related to mastectomy and breast conserving surgery with radiation.

Principal Findings. Half (51 percent) of respondents had survival knowledge, while close to half (47.6 percent) were uncertain regarding recurrence knowledge. Minority patients and those with lower education were less likely to have adequate survival knowledge and more likely to be uncertain regarding recurrence risk than their counterparts (p<.001). Neither surgeon characteristics nor treatment location attenuated racial/ethnic knowledge disparities. Patient–physician communication was significantly (p<.001) associated with both types of knowledge, but did not influence racial/ethnic differences in knowledge.

Conclusions. Interventions to improve patient understanding of the benefits and risks of breast cancer treatments are needed across surgeons and treatment setting, particularly for racial/ethnic minority women with breast cancer.

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