Comparing treatment and outcomes of ductal carcinoma in situ among women in Missouri by race
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To investigate whether treatment (surgery, radiation therapy, and endocrine therapy) contributes to racial disparities in outcomes of ductal carcinoma in situ (DCIS).
Patients and methods
The analysis included 8184 non-Hispanic White and 954 non-Hispanic Black women diagnosed with DCIS between 1996 and 2011 and identified in the Missouri Cancer Registry. Logistic regression models were used to estimate odds ratios (ORs) of treatment for race. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of ipsilateral breast tumor (IBT) and contralateral breast tumor (CBT) for race.
There was no significant difference between Black and White women in utilization of mastectomy (OR 1.16; 95 % CI 0.99–1.35) or endocrine therapy (OR 1.19; 95 % CI 0.94–1.51). Despite no significant difference in underutilization of radiation therapy (OR 1.14; 95 % CI 0.92–1.42), Black women had higher odds of radiation delay, defined as at least 8 weeks between surgery and radiation (OR 1.92; 95 % CI 1.55–2.37). Among 9138 patients, 184 had IBTs and 326 had CBTs. Black women had a higher risk of IBTs (HR 1.69; 95 % CI 1.15–2.50) and a comparable risk of CBTs (HR 1.19; 95 % CI 0.84–1.68), which were independent of pathological features and treatment.
Racial differences in DCIS treatment and outcomes exist in Missouri. This study could not completely explain the higher risk of IBTs in Black women. Future studies should identify differences in timely initiation and completion of treatment, which may contribute to the racial difference in IBTs after DCIS.
KeywordsBreast cancer Ductal carcinoma in situ Race Second breast tumors Cancer disparity
Drs. Liu and Madubata had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design Madubata, Liu, Colditz. Acquisition of data Yun, Lian, Liu, Colditz. Analysis and interpretation of data Madubata, Liu, Goodman, Yun, Yu, Lian, Colditz. Drafting of the manuscript Madubata, Liu, Colditz. Critical revision of the manuscript for important intellectual comment Liu, Colditz, Yun, Madubata, Goodman, Yu, Lian. Statistical analysis Liu, Madubata, Lian, Colditz.
Chinwe C. Madubata was funded by Grant Numbers UL1 TR000448 and TL1 TR000449 from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health. Drs. Colditz and Liu are supported, in part, by the Breast Cancer Research Foundation and the Foundation for Barnes-Jewish Hospital. Dr. Yu is supported by the NIH Surgical Oncology Training Grant 5T32CA9621-27. Dr. Lian is supported, in part, by a Career Development Award from the National Cancer Institute (K07 CA178331). We thank the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, MO, for the use of the Biostatistics Shared Resource. The Siteman Cancer Center is supported in part by NCI Cancer Center Support Grant #P30 CA091842, Eberlein, PI.
Compliance with ethical standards
Conflict of Interest
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