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

  • Epidemiology
  • Published:
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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.

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Acknowledgments

Dr. Livaudais was supported by NCRR Grant TL1 RR025016 and NCI Grant R25 CA092408. Dr. Hershman is the recipient of a grant from the American Cancer Society (RSGT-08-009-01-CPHPS). Dr. Kushi is the recipient of a grant from the National Cancer Institute (R01 CA105274). Dr. Gomez is the recipient of a grant from the Surveillance Epidemiology and End Results Rapid Response Surveillance Study under contracts from N01-PC-35136. Dr. Neugut is the recipient of a grant from the Department of Defense (BC043120). Dr. Habel is the recipient of a grant from the National Cancer Institute (R01 CA98838).

Conflict of interest

The authors have no financial conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Health Evidence and Policy, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY, 10029, USA

    Jennifer C. Livaudais

  2. Department of Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Dawn L. Hershman & Alfred I. Neugut

  3. Kaiser Division of Research, Oakland, CA, USA

    Laurel Habel, Lawrence Kushi & Louis Fehrenbacher

  4. Cancer Prevention Institute of California, Fremont, CA, USA

    Scarlett Lin Gomez

  5. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Christopher I. Li & Beti Thompson

  6. University of Washington School of Public Health, Seattle, WA, USA

    Christopher I. Li & Beti Thompson

  7. The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Gloria D. Coronado

Authors
  1. Jennifer C. Livaudais
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  2. Dawn L. Hershman
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  3. Laurel Habel
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  4. Lawrence Kushi
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  5. Scarlett Lin Gomez
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  6. Christopher I. Li
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  7. Alfred I. Neugut
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  8. Louis Fehrenbacher
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  9. Beti Thompson
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  10. Gloria D. Coronado
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Corresponding author

Correspondence to Jennifer C. Livaudais.

Additional information

This work was conducted while Jennifer Livaudais was a doctoral student at the University of Washington, School of Public Health, and a research fellow at the Fred Hutchinson Cancer Research Center, Seattle, WA.

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Livaudais, J.C., Hershman, D.L., Habel, L. et al. Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. Breast Cancer Res Treat 131, 607–617 (2012). https://doi.org/10.1007/s10549-011-1762-1

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  • DOI: https://doi.org/10.1007/s10549-011-1762-1

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