It is an unfortunate reality that unequal access to care persists as a significant cause of health outcome disparities. In this issue of JAMA Surgery, Lautner et al1 use statistics from the National Cancer Data Base to document this public health concern in the setting of surgical treatment for early-stage breast cancer.
Optimal breast-conserving surgery for most lumpectomy-eligible patients requires a commitment to whole-breast radiation, delivered in daily fractions during a 6-week period. However, this strategy requires access to a radiation oncologist and specialized treatment facility. Patients who lack daily transportation access, patients who cannot coordinate radiation treatments with job and/or child care responsibilities, and patients who live remote from a radiation facility face often insurmountable barriers to pursuing breast-conserving surgery, even if they have a disease pattern that is ideally suited for this treatment. Socioeconomically disadvantaged patients are typically the ones who face these obstacles, and these burdens of financial deprivation are disproportionately faced by minority racial/ethnic groups and rural communities. While some increases in the use of breast-conserving therapy between 1998 and 2011 were observed, Lautner and colleagues confirmed that socioeconomic disparities and distance from radiation facilities were persistently associated with reduced use of breast-conserving therapy.
Newman LA. Ongoing Consequences of Disparities in Breast Cancer Surgery. JAMA Surg. 2015;150(8):786. doi:10.1001/jamasurg.2015.1114