Disparities in Use of Breast-Conserving Therapy for Early-Stage Breast Cancer
In a study using National Cancer Data Base data reported in JAMA Surgery, Lautner et al identified several factors associated with the use of breast-conserving therapy in women with early-stage breast cancer, including older age, higher education and income, private insurance, treatment at an academic center, and residence closer to a treatment center.
The study included data from 727,927 women in the National Cancer Data Base treated for stage T1 or T2 disease between 1998 and 2011.
Factors Associated With Breast-Conserving Therapy Use
On multivariate analysis, breast-conserving therapy use was greater in patients aged 52 to 61 years (odds ratio [OR] = 1.14, 95% confidence interval [CI] =1.12–1.15) and 62 to 70 years (OR = 1.09, 95% CI = 1.07–1.11) vs those aged 18 to 51 years and in areas with the highest vs lowest educational level (OR =1.16, 95% CI = 1.14–1.19). Rates of breast-conserving therapy were lower in patients without insurance or with Medicaid or Medicare (ORs = 0.75–0.84, all significant) and among those with the lowest vs highest median income (OR = 0.92, 95% CI = 0.90–0.94). Greater breast-conserving therapy use was also associated with treatment in academic vs community cancer programs (OR = 1.13, 95% CI = 1.11–1.15), residence in the U.S. Northeast region vs Southern region (OR = 1.50, 95% CI = 1.48–1.52), and residence within 27.8 km of vs farther from a treatment facility (OR = 1.25, 95% CI = 1.23–1.27).
Changes Over Time
Use of breast-conserving therapy increased between 1998 and 2011 (from 48.2% to 59.7%), with use significantly more likely in 2011 vs 1998 (OR = 1.25, 95% CI = 1.21–1.28). Increases were observed across age groups. Increases over time were also observed in community cancer programs (from 48.4% to 58.8%) and in facilities located in the South (from 45.1% to 55.3%).
The investigators concluded: “Although the use of [breast-conserving therapy] has increased during the past 14 years, nonclinical factors, including socioeconomic demographics, insurance, and travel distance to the treatment facility, persist as key barriers to receipt of [breast-conserving therapy]. Interventions that address these barriers may facilitate further uptake of [breast-conserving therapy].”
The study was supported by a grant from The University of Texas MD Anderson Cancer Center.
Isabelle Bedrosian, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author of the JAMA Surgery article.
The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
