Breast Cancer Research and Treatment

, Volume 109, Issue 3, pp 545–557 | Cite as

Parity and disparity in first course treatment of invasive breast cancer

  • Mary Jo Lund
  • Otis P. Brawley
  • Kevin C. Ward
  • John L. Young
  • Sheryl S. G. Gabram
  • J. William Eley
Epidemiology

Abstract

Background Adherence to first course treatment guidelines for breast cancer may not be uniform across racial/ethnic groups and could be a major contributing factor to disparities in outcome. In this population-based study, we assessed racial differences in initial treatment of breast cancer. Methods Surveillance, Epidemiology, and End Results (SEER) program data were used to study all primary invasive breast cancers diagnosed during 2000–2001 among Black (n = 877) and White (n = 2437) female residents of the five Atlanta SEER counties, counties with several large teaching hospitals. Differences in treatment delay, cancer directed surgery, and receipt of chemotherapy, radiotherapy, or hormonal therapy were analyzed according to guidelines for treatment. Analyses utilized frequency distributions, χ2 tests of independence and statistics in and across strata. Results Black women experienced longer treatment delays, regardless of stage at diagnosis, and were 4–5 fold more likely to experience delays greater than 60 days (P < 0.001). For local–regional disease, more Black women did not receive cancer directed surgery (7.5% vs. 1.5% of white women, P < 0.001), but did receive breast conserving surgery (BCS) equivalently. Only 61% of Black vs. 72% of White women received radiation with BCS (P < 0.001). Black women eligible for hormonal therapy were less likely to receive it (P < 0.001). Conclusion Our findings suggest treatment standards are not adequately or equivalently met among Black and White women, even in an area where teaching hospitals provide a substantial portion of breast cancer care. Treatment differences can adversely affect outcome and reasons for the differences need to be addressed.

Keywords

Breast neoplasms Racial disparity Treatment 

Abbreviations

BCS

Breast Conserving Surgery

ER

Estrogen Receptor

PR

Progesterone Receptor

+

Positive

SEER

Surveillance, Epidemiology, and End Results

NOS

Not otherwise specified

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Mary Jo Lund
    • 1
    • 2
    • 3
    • 4
  • Otis P. Brawley
    • 1
    • 2
    • 3
    • 4
  • Kevin C. Ward
    • 1
    • 5
  • John L. Young
    • 1
    • 5
  • Sheryl S. G. Gabram
    • 3
    • 4
  • J. William Eley
    • 2
    • 4
  1. 1.Department of EpidemiologyRollins School of Public Health, Emory UniversityAtlantaUSA
  2. 2.Winship Cancer InstituteEmory University School of MedicineAtlantaUSA
  3. 3.Georgia Cancer Center for Excellence at GradyAtlantaUSA
  4. 4.Emory University School of MedicineAtlantaUSA
  5. 5.Georgia Center for Cancer StatisticsAtlantaUSA

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