Annals of Surgical Oncology

, Volume 15, Issue 7, pp 1828–1836 | Cite as

Urban/Rural Residence Moderates Effect of Race on Receipt of Surgery in Patients with Nonmetastatic Breast Cancer: A Report from the South Carolina Central Cancer Registry

  • N. F. Esnaola
  • K. Knott
  • C. Finney
  • M. Gebregziabher
  • M. E. Ford
Healthcare Policy and Outcomes

Abstract

Background

Surgical resection is the cornerstone of therapy in patients with nonmetastatic breast cancer. Previous studies have reported underuse of adjuvant therapy among African Americans (AA). This study explores the independent effect of race on surgical resection in a recent, population-based sample of breast cancer patients.

Methods

All cases of nonmetastatic breast cancer reported to the our state Cancer Registry between 1996 and 2002 were identified and linked to the state Inpatient/Outpatient Surgery Files and the 2000 Census. Characteristics between Caucasian and AA patients were compared using Student’s t and chi-square tests. Odds ratios (OR) of resection and 95% confidence intervals (CI) were calculated using logistic regression.

Results

We identified 12,404 Caucasian and 3,411 AA women. AA patients were more likely to be younger, non-married, have greater comorbidity, reside in rural communities, be less educated, live in poverty, and be uninsured or covered by Medicaid (all P < 0.0001). AA patients were slightly less likely to undergo resection compared to Caucasian patients (94.9% versus 96.4%, P < 0.0001). An interaction effect between race and urban/rural patient residence was observed (P = 0.003). After controlling for other factors, the adjusted OR for resection for urban AA patients was 0.58 (95% CI 0.41–0.82). In contrast, race had no effect on resection among rural patients (OR = 1.02; 95% CI 0.70–1.47).

Conclusions

AA race is an independent predictor of underuse of surgery among urban patients with breast cancer, while rural residence is associated with underuse of surgery, irrespective of race. Interventions designed to optimize surgical cancer care should target these vulnerable populations.

Keywords

Breast cancer Race Residence Socioeconomic status Resection 

References

  1. 1.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. CA Cancer J Clin 2007; 57:43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Brawley OW. Disaggregating the effects of race and poverty on breast cancer outcomes. J Natl Cancer Inst 2002; 94:471–3PubMedGoogle Scholar
  3. 3.
    Chu KC, Tarone RE, Brawley OW. Breast cancer trends of black women compared with white women. Arch Fam Med 1999; 8:521–8PubMedCrossRefGoogle Scholar
  4. 4.
    Chevarley F, White E. Recent trends in breast cancer mortality among white and black US women. Am J Public Health 1997; 87:775–81PubMedGoogle Scholar
  5. 5.
    Jatoi I, Anderson WF, Rao SR, et al. Breast cancer trends among black and white women in the United States. J Clin Oncol 2005; 23:7836–41PubMedCrossRefGoogle Scholar
  6. 6.
    Kimmick G, Muss HB, Case LD, et al. A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer. The Piedmont Oncology Association experience. Cancer 1991; 67:2850–4PubMedCrossRefGoogle Scholar
  7. 7.
    Roach M, 3rd, Cirrincione C, Budman D, et al. Race and survival from breast cancer: based on Cancer and Leukemia Group B trial 8541. Cancer J Sci Am 1997; 3:107–12Google Scholar
  8. 8.
    Dignam JJ, Redmond CK, Fisher B, et al. Prognosis among African-American women and white women with lymph node negative breast carcinoma: findings from two randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP). Cancer 1997; 80:80–90PubMedCrossRefGoogle Scholar
  9. 9.
    Du WSM. Racial disparities in treatment and survival of women with stage I-III breast cancer at a large academic medical center in metropolitan Detroit. Breast Cancer Res Treat 2005; 91:243–8PubMedCrossRefGoogle Scholar
  10. 10.
    Connor CS, Touijer AK, Krishnan L, et al. Local recurrence following breast conservation therapy in African-American women with invasive breast cancer. Am J Surg 2000; 179:22–6PubMedCrossRefGoogle Scholar
  11. 11.
    Dignam JJ. Efficacy of systemic adjuvant therapy for breast cancer in African-American and Caucasian women. J Natl Cancer Inst Monogr 2001:36–43Google Scholar
  12. 12.
    Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst 2002; 94:334–57PubMedGoogle Scholar
  13. 13.
    Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 2006; 24:1357–62PubMedCrossRefGoogle Scholar
  14. 14.
    Muss HB, Hunter CP, Wesley M, et al. Treatment plans for black and white women with stage II node-positive breast cancer. The National Cancer Institute Black/White Cancer Survival Study experience. Cancer 1992; 70:2460–7PubMedCrossRefGoogle Scholar
  15. 15.
    Heimann R, Ferguson D, Powers C, et al. Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation. J Clin Oncol 1997; 15:2329–37PubMedGoogle Scholar
  16. 16.
    Michalski TA, Nattinger AB. The influence of black race and socioeconomic status on the use of breast-conserving surgery for Medicare beneficiaries. Cancer 1997; 79:314–9PubMedCrossRefGoogle Scholar
  17. 17.
    Velanovich V, Yood MU, Bawle U, et al. Racial differences in the presentation and surgical management of breast cancer. Surgery 1999; 125:375–9PubMedGoogle Scholar
  18. 18.
    Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 2002; 94:490–6PubMedGoogle Scholar
  19. 19.
    Fritz A, Percy C, Jack A, et al. International Classification of Diseases for Oncology. Geneva: World Health Organization, 2000Google Scholar
  20. 20.
    SEER Summary Staging Manual 2000. Available: http://www.seer.cancer.gov/tools/ssm/
  21. 21.
    Johnson C. Registry operations and data standards. Vol. 2. Chicago: American College of Surgeons, 1996Google Scholar
  22. 22.
    Johnson C. (1998) Registry operations and data standards, Revised (Appendix D, Surgery Codes). Vol. 2. Chicago: American College of SurgeonsGoogle Scholar
  23. 23.
    Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993; 46:1075–9; discussion 1081–90PubMedCrossRefGoogle Scholar
  24. 24.
    United States Department of Health and Human Services: Poverty Guidelines, Research, and Measurement. Available: http://www.aspe.hhs.gov/poverty/index.shtml (accessed 6/24/2006)
  25. 25.
    Osteen RT, Steele GD Jr, Menck HR, et al. Regional differences in surgical management of breast cancer. CA Cancer J Clin 1992; 42:39–43PubMedCrossRefGoogle Scholar
  26. 26.
    McGinnis LS, Menck HR, Eyre HJ, et al. National Cancer Data Base survey of breast cancer management for patients from low income zip codes. Cancer 2000; 88:933–45PubMedCrossRefGoogle Scholar
  27. 27.
    Mandelblatt JS, Kerner JF, Hadley J, et al. Variations in breast carcinoma treatment in older Medicare beneficiaries: Is it black or white. Cancer 2002; 95:1401–14PubMedCrossRefGoogle Scholar
  28. 28.
    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; 326:1102–7PubMedGoogle Scholar
  29. 29.
    Dunmore C, Plummer P, Regan G, et al. Re: Race and differences in breast cancer survival in a managed care population. J Natl Cancer Inst 2000; 92:1690–1PubMedCrossRefGoogle Scholar
  30. 30.
    Bryant H, Mah Z. Breast cancer screening attitudes and behaviors of rural and urban women. Prev Med 1992; 21:405–18PubMedCrossRefGoogle Scholar
  31. 31.
    Rural Policy Research Institute. Welfare Reform in Rural America: A Review of Current Research, 2001Google Scholar
  32. 32.
    Fletcher C FJ, Gaddis B, Winter M, et al. Small towns and welfare reform: Iowa case studies of families and communities. Rural dimensions of welfare reform: A research conference on poverty, welfare, and food assistance. Washington, DC: Georgetown University, 2000Google Scholar
  33. 33.
    Schur C FS. Access to health care. Rural health in the United States. New York: Oxford University Press, 1999Google Scholar
  34. 34.
    National Advisory Committee on Rural Health. Medicare Reform: A Rural Perspective, 2001Google Scholar
  35. 35.
    HHS Rural Task Force Report to the Secretary. One Department Serving Rural America, 2002Google Scholar
  36. 36.
    Bland KI, Menck HR, Scott-Conner CE, et al. The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States. Cancer 1998; 83:1262–73PubMedCrossRefGoogle Scholar
  37. 37.
    Krieger N, Chen JT, Waterman PD, et al. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? The Public Health Disparities Geocoding Project. Am J Epidemiol 2002; 156:471–82PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • N. F. Esnaola
    • 1
  • K. Knott
    • 2
  • C. Finney
    • 3
  • M. Gebregziabher
    • 2
  • M. E. Ford
    • 2
  1. 1.Department of SurgeryMedical University of South Carolina (MUSC)CharlestonUSA
  2. 2.Department of Biometry and EpidemiologyMedical University of South Carolina (MUSC)CharlestonUSA
  3. 3.South Carolina Office of Research and Statistics (ORS)ColumbiaUSA

Personalised recommendations