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Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study



Racial/ethnic disparities in breast cancer outcomes may be related to quality of care and reflected in emergency department (ED) visits following primary treatment. We examined racial/ethnic variation in ED visits following breast cancer surgery.


Using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development, we identified 151,229 women diagnosed with stage 0-III breast cancer between 2005 and 2013 who received surgical treatment. Differences in odds of having at least one breast cancer-related ED visit within 90 days post-surgery were estimated with logistic regression controlling for clinical and sociodemographic variables. Secondary analyses examined health care-related moderators of disparities.


Hispanics and non-Hispanic (NH) Blacks had an increased likelihood of having an ED visit within 90 days of surgery compared to NH Whites [OR = 1.11 (1.04–1.18), p = 0.0016; OR = 1.38 (1.27–1.50), p < 0.0001, respectively]; the likelihood was reduced in Asian/Pacific Islanders [aOR = 0.77 (0.71–0.84), p < 0.0001]. Medicaid and Medicare (vs. commercial insurance) increased the likelihood of ED visit for NH Whites, and to a lesser degree for Hispanics and NH Blacks (p < 0.0001 for interaction). Receipt of surgery at an NCI-designated Comprehensive Cancer Center or at a for-profit (vs. non-profit) hospital was associated with reduced likelihood of ED visits for all groups.


Racial/ethnic disparities in ED visits following breast cancer surgery persist after controlling for clinical and sociodemographic variables. Improving quality of care following breast cancer surgery could improve outcomes for all groups.

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Due to the Data Use Agreement with the California Cancer Registry (CCR), the data underlying this article cannot be shared publicly. Researchers interested in accessing CCR data may submit a request as detailed at


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This work was supported by the National Institutes of Health (R35 CA197461 to C.L.) and the Population Research Core and Data Science Core of the USC Norris Comprehensive Cancer Center (P30 CA014089 to USC Norris Comprehensive Cancer Center). The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

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Authors and Affiliations



Mary Falcone: Formal analysis, methodology, project administration, visualization, writing—original draft, writing—review & editing. Lihua Liu: Data curation, methodology, writing—review & editing. Albert Farias: Methodology, writing—review & editing. JuanJuan Zhang: Data curation, methodology, writing—review & editing. Irene Kang: Methodology; writing—review & editing. Ming Li: Formal analysis, Methodology; Writing—review & editing. Mariana C. Stern: Methodology; writing—review & editing. Caryn Lerman: Conceptualization, funding acquisition, methodology, supervision, writing—review & editing.

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Correspondence to Caryn Lerman.

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Conflict of interest

Dr. Kang is on the speaker’s bureau and served as a consultant for Puma Biotechnology, and has participated in an advisory board for Bristol-Myers Squibb. The other authors report nothing to disclose.

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This study was approved by the University of California Institutional Review Board.

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Informed consent was waived for this retrospective analysis of deidentified data.

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Falcone, M., Liu, L., Farias, A. et al. Evidence for racial/ethnic disparities in emergency department visits following breast cancer surgery among women in California: a population-based study. Breast Cancer Res Treat 187, 831–841 (2021).

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  • Breast cancer
  • Health disparities
  • Emergency department visits