R. Yang1, Y. Ma1, I. Wapnir1, K. F. Rhoads1 1Stanford University,Department Of Surgery,Palo Alto, CA, USA
Introduction:
Disparities in breast cancer have persisted over decades. While survival for White patients has improved, survival in select minority groups has worsened, thus widening the pre-existing gap. Biological factors have been well-studied, but it is not yet known if differences in breast cancer care contribute to worsening racial disparities. We aimed to evaluate differences in the receipt of transdisciplinary evidence-based breast cancer care for racial/ethnic minorities in California (2008-2009).
Methods:
California Cancer Registry (CCR) data were linked to state level inpatient and ambulatory surgery data and used to identify all women with an ICD-03 diagnosis of breast cancer who were treated during the years under study. We identified quality measures reflecting evidence-based care in the diagnosis, surgical treatments, and adjuvant treatments of breast cancer based on current literature and National Comprehensive Cancer Network guidelines. We evaluated the receipt of percutaneous versus excisional biopsy, neoadjuvant chemotherapy for tumor stage T4, chemotherapy for nodal stage N2, radiation therapy following lumpectomy; surgical evaluation of the axilla for stage M0; breast conservation for tumor stage T1 or T2; and breast reconstruction following mastectomy. Differences in receipt of evidence-based care by race/ethnicity were determined using the chi-squared test.
Results:
We identified 42,474 patients with stage I-IV breast cancer. We found that a higher proportion of Black patients (3.1%) underwent excisional biopsy compared to White, Hispanic, and API patients (2.2%, 2.5%, 2.6%, respectively, (p=0.02)). There was no significant difference in the receipt of systemic chemotherapy for nodal stage N2 by patient race (p=0.09). API patients had the lowest rates of neoadjuvant chemotherapy for T4 tumors (24.7%) compared to all other races (Black 28.4%, White 29.8%, Hispanic 42.9%, p=0.007). Radiation following lumpectomy was less frequent for Black (54.9%) and Hispanic patients (60.5%) compared to White (64.9%) and API patients (67.4%, p<0.001). Evaluation of the axilla (either SLNB or axillary dissection) for M0 disease was lower for Black (39.1%), Hispanic (40.6%), and API patients (44.4%) compared to White patients (48.3%, p<0.001). Rates of breast conserving surgery for T1 or T2 tumors were lower among API (45.9%), Hispanic (47.6%), and Black patients (50.1%) compared to White patients (53.4%, p<0.001). Rates of breast reconstruction following mastectomy were lower among Black (34.9%), Hispanic (34.3%), and API patients (36.0%) compared to White patients (40.8%, p<0.001).
Conclusion:
Racial disparities in the quality of care exist across diagnostic, surgical and adjuvant therapies. However, the disparities appear most pronounced within the surgical care. Further studies are needed to determine the drivers of this disparity.