Abstract
BACKGROUND: Breast-conserving surgery (BCS) has been the recommended treatment for early-stage breast cancer since 1990 yet many women still do not receive this procedure.
OBJECTIVE: To examine the relationship between birthplace and use of BCS in Asian-American and Pacific-Islander (AAPI) women, and to determine whether disparities between white and AAPI women persist over time.
DESIGN: Retrospective cohort study.
SETTING AND PARTICIPANTS: Women with newly diagnosed stage I or II breast cancer from 1992 to 2000 in the Surveillance, Epidemiology, and End Results program.
OUTCOME: Receipt of breast -conserving surgery for initial treatment of stage I or II breast cancer.
MAIN RESULTS: Overall, AAPI women had lower rates of BCS than white women (47% vs 59%; P<.01). Foreign-born AAPI women had lower rates of BCS than U.S.-born AAPI and white women (43% vs 56% vs 59%; P<.01). After adjustment for age, marital status, tumor registry, year of diagnosis, stage at diagnosis, tumor size, histology, grade, and hormone receptor status, foreign-born AAPI women (adjusted OR [aOR], 0.49; 95% CI, 0.32 to 0.76) and U.S.-born AAPI women (aOR, 0.77; 95% CI, 0.62 to 0.95) had lower odds of receiving BCS than white women. Use of BCS increased over time for each racial/ethnic group; however, foreign-born AAPI women had persistently lower rates of BCS than non-Hispanic white women.
CONCLUSIONS: AAPI women, especially those who are foreign born, are less likely to receive BCS than non-Hispanic white women. Of particular concern, differences in BCS use among foreign-born and U.S.-born AAPI women and non-Hispanic white women have persisted over time. These differences may reflect inequities in the treatment of early-stage breast cancer for AAPI women, particularly those born abroad.
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References
Treatment of early-stage breast cancer. NIH Consensus Statement. Online 1990 June 18–21 (cited 2005 April 11); 8(6); 1–19.
Fisher B, Anderson S, Redmond C, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–61.
Kiebert GM, de Haes JC, van de Velde CJ. The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: A review. J Clin Oncol. 1991;9:1059–70.
Farrow DC, Hunt WC, Samet JM. Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992;326:1097–101.
Joslyn SA. Racial differences in treatment and survival from early-stage breast carcinoma. Cancer. 2002;95:1759–66.
Gilligan MA, Kneusel FT, Hoffman RG, et al. Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption. Med Care. 2002;40:181–9.
Nattinger AB, Gottlieb MS, Veum J, et al. Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med. 1992;326:1102–7.
Ayanian JZ, Guadagnoli E. Variations in breast cancer treatment by patient and provider characteristics. Breast Cancer Res Treat. 1996;40:65–74.
Johantgen ME, Coffey RM, Harris DR, et al. Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery. Am J Public Health. 1995;85:1432–4.
Kagawa-Singer M, Wellisch DK, Durvasula R. Impact of breast cancer on Asian American and Anglo American women. Cult Med Psychiatry. 1997;21:449–80.
Morris CR, Cohen R, Schlag R, et al. Increasing trends in the use of breast-conserving surgery in California. Am J Public Health. 2000;90:281–4.
Lin SS, Phan JC, Lin AY. Breast cancer characteristics of Vietnamese women in the Greater San Francisco Bay Area. West J Med. 2002;176:87–91.
Prehn AW, Topol B, Stewart S. Differences in treatment patterns for localized breast carcinoma among Asian/Pacific Islander women. Cancer. 2002;95:2268–75.
Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;163:49–56.
Frisbie WP, Cho Y, Hummer RA. Immigration and the health of Asian and Pacific Islander adults in the United States. Am J Epidemiol. 2001;153:372–80.
Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Aff. 2001;20:247–56.
Fox SA, Stein JA. The effect of physician-patient communication on mammography utilization by different ethnic groups. Med Care. 1991;29:1065–82.
Woloshin S, Schwartz LM, Katz SJ, Welch HG. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997;12:472–7.
Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventative services by Hispanics: findings from NHANES 1982–1984. Am J Public Health. 1990;80(suppl.):11–9.
Goel MS, Wee CC, McCarthy EP, et al. Racial and ethnic disparities in cancer screening: the importance of foreign-birth as a barrier to care. J Gen Intern Med. 2003;18:1028–35.
Ngo-Metzger Q, McCarthy EP, Burns RB, et al. Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients. Am J Med. 2003;115:47–53.
Surveillance, Epidemiology, and End Results (SEER) Program. Public-Use Data (1973–2000), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2003, based on the November 2002 submission. Available at: http://www.seer.cancer.gov. Accessed February 2, 2004.
Lin SS, Clarke CA, O’Malley CD, et al. Studying cancer incidence and outcomes in immigrants: methodological concerns. Am J Public Health. 2002;92:1757–9.
Schmidley AD. U.S. Census Bureau, Current Population Reports, Series P23-206, Profile of the Foreign-born Population in the United States: 2000. Washington, DC: U.S. Government Printing Office; 2001.
Online Help Manual. SUDAAN Version 8.1. Research Triangle Park, NC: Research Triangle Institute. Available at: http://www.rti.org/sudaan. Accessed February 2, 2004.
U.S. Census Bureau. Age by Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over (PCT38). Census 2000 Summary File 4. Available at: http://www.census.gov. Accessed February 3, 2004.
Liang W, Burnett CB, Rowland JH, et al. Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol. 2002;20:1008–16.
Fung KW, Lau Y, Fielding R, et al. The impact of mastectomy, breast-conserving treatment and immediate breast reconstruction on the quality of life of Chinese women. ANZ J Surg. 2001;71:202–6.
Barlow WE, Taplin SH, Yoshida CK, et al. Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer. J Natl Cancer Inst. 2001;93:447–55.
Deapen D, Liu L, Perckins C, et al. Rapidly rising breast cancer incidence rates among Asian-American women. Int J Cancer. 2002;99:747–50.
Wingo PA, Ries LAG, Rosenberg HM, et al. Cancer incidence and mortality, 1973–1995: a report card for the U.S. Cancer. 1998;82:1197–207.
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None of the organizations funding the investigators had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Dr. Goel was supported by an institutional National Research Service Award (5T32PE11001-15) and by the Ryoichi Sasakawa Fund at the time this research was conducted. Dr. McCarthy is the recipient of a First Independent Research and Transition Award from the National Cancer Institute (R29 CA79052). Dr. Phillips is supported by a Mid-Career Investigator Award from the National Institutes of Health (K24 AT00589-01A1). Dr. Ngo-Metzger is supported by the National Cancer Institute Asian American Network for Cancer Awareness, Research and Training (U01 CA86322).
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Goel, M.S., Burns, R.B., Phillips, R.S. et al. Trends in breast conserving surgery among Asian Americans and Pacific Islanders, 1992–2000. J GEN INTERN MED 20, 604–611 (2005). https://doi.org/10.1007/s11606-005-0107-3
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DOI: https://doi.org/10.1007/s11606-005-0107-3