Breast Cancer Research and Treatment

, Volume 131, Issue 2, pp 607–617

Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer

  • Jennifer C. Livaudais
  • Dawn L. Hershman
  • Laurel Habel
  • Lawrence Kushi
  • Scarlett Lin Gomez
  • Christopher I. Li
  • Alfred I. Neugut
  • Louis Fehrenbacher
  • Beti Thompson
  • Gloria D. Coronado
Epidemiology

DOI: 10.1007/s10549-011-1762-1

Cite this article as:
Livaudais, J.C., Hershman, D.L., Habel, L. et al. Breast Cancer Res Treat (2012) 131: 607. doi:10.1007/s10549-011-1762-1

Abstract

Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20–79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR] = 0.82; [CI] 0.71–0.96 and [OR] = 0.78; [CI] 0.63–0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.

Keywords

Breast cancerAdjuvant hormonal therapyTamoxifenAromatase inhibitorsRacial/ethnic disparities

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Jennifer C. Livaudais
    • 1
  • Dawn L. Hershman
    • 2
  • Laurel Habel
    • 3
  • Lawrence Kushi
    • 3
  • Scarlett Lin Gomez
    • 4
  • Christopher I. Li
    • 5
    • 6
  • Alfred I. Neugut
    • 2
  • Louis Fehrenbacher
    • 3
  • Beti Thompson
    • 5
    • 6
  • Gloria D. Coronado
    • 7
  1. 1.Department of Health Evidence and PolicyMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of Medicine and the Herbert Irving Comprehensive Cancer CenterColumbia University Medical CenterNew YorkUSA
  3. 3.Kaiser Division of ResearchOaklandUSA
  4. 4.Cancer Prevention Institute of CaliforniaFremontUSA
  5. 5.Fred Hutchinson Cancer Research CenterSeattleUSA
  6. 6.University of Washington School of Public HealthSeattleUSA
  7. 7.The Center for Health Research, Kaiser Permanente NorthwestPortlandUSA