Racial differences in breast cancer care ‘unaffected by insurance and social status’
MedWire News: Racial differences exist in breast cancer care, even after taking into account patient insurance and socioeconomic status (SES), conclude US investigators who call for efforts to improve outcomes in women with potentially curable disease.
Previous studies have shown that Black and Hispanic women receive less recommended breast cancer care than White women, including lower rates of definitive therapy and radiation after breast-conserving surgery.
To determine whether insurance and SES are associated with racial/ethnic differences in breast cancer care, Rachel Freedman, from Dana Faber Cancer Institute in Boston, Massachusetts, and colleagues examined the likelihood of 662,117 women diagnosed with invasive breast cancer between 1998 and 2005 receiving definitive locoregional therapy, hormone receptor testing, and adjuvant systemic therapy.
In all, 86% of the women were White, 10% were Black, and 4% were Hispanic, and the majority had either private insurance (51%) or Medicare (41%), the research team reports in the journal Cancer.
Definitive locoregional therapy was administered to 80.0% of eligible (stage I/II) patients, while 98.5% of eligible (stage I-IV) patients received hormone receptor testing. Aduvant hormonal therapy and chemotherapy was given to 53.1% and 50.2% of eligible (stage I-III) patients, respectively.
Multivariate logistic regression analysis indicated that Black women were less likely than White women to receive definitive locoregional therapy, adjuvant hormonal therapy, and adjuvant chemotherapy, at odds ratios (ORs) of 0.91, 0.90, and 0.87. Hispanic women were also less likely than White women to receive adjuvant hormonal therapy, at an OR of 0.94.
There were no racial/ethnic differences in the receipt of hormone receptor testing, with ORs of 0.99 and 1.23 for Black and Hispanic women versus White women, respectively.
Crucially, Freedman and team found that the results were not substantially altered after taking into account the women's insurance and SES, although uninsured women were typically less likely to receive recommended treatments.
They conclude: "Despite efforts to eliminate disparities in cancer care in recent years, our study of a large, hospital-based sample suggests that modest racial differences in receipt of recommended breast cancer care persist even after adjustment for insurance and area-level SES.
"Although health insurance expansion may resolve disparities in treatment by health insurance status, this study suggests that expansion of insurance coverage alone is unlikely to have a major impact on disparities in breast cancer care among Black women."
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By Liam Davenport