Disparities in the Use of Breast-Conserving Therapy Among Patients With Early-Stage Breast Cancer | Breast Cancer | JAMA Surgery | JAMA Network
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Original Investigation
August 2015

Disparities in the Use of Breast-Conserving Therapy Among Patients With Early-Stage Breast Cancer

Author Affiliations
  • 1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
  • 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
  • 3Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
JAMA Surg. 2015;150(8):778-786. doi:10.1001/jamasurg.2015.1102
Abstract

Importance  Although breast-conserving therapy (BCT) is an accepted modality for treatment of early-stage breast cancer, many women continue to undergo mastectomy. Detailing the factors associated with choice of BCT may assist with overcoming barriers in the use of this treatment modality.

Objective  To conduct a population-based examination of the factors that influence the use of BCT.

Design, Setting, and Participants  Using the National Cancer Data Base, we examined the surgical choices of women with stage T1 or T2 breast cancer treated between 1998 and 2011. Logistic regression analysis conducted between September 19, 2013, and August 26, 2014, was used to assess the multivariate association between patient and facility variables and the probability of undergoing BCT.

Main Outcomes and Measures  Factors associated with the use of BCT.

Results  A cohort of 727 927 women was identified in the National Cancer Data Base. Use of BCT, determined using odds ratio (OR) and 95% CI, was greater in patients aged 52 to 61 years compared with younger patients (1.14; 1.12-1.15) and in those with the highest educational level (1.16; 1.14-1.19). Rates of BCT were lower in patients without insurance compared with those with private insurance (0.75; 0.72-0.78) and in those with the lowest median income (0.92; 0.90-0.94). Academic cancer programs, US Northeast location, and residence within 27.8 km of a treatment facility were associated with greater BCT rates than were community cancer programs (1.13; 1.11-1.15), Southern location (1.50; 1.48-1.52), and residence farther from a treatment facility (1.25; 1.23-1.27). When comparing BCT use in 1998 with use in 2011, increases were seen across age groups (from 48.2% to 59.7%), in community cancer programs (48.4% in 1998 vs 58.8% in 2011), and in facilities located in the South (45.1% in 1998 vs 55.3% in 2011).

Conclusions and Relevance  Although the use of BCT has increased during the past 14 years, nonclinical factors, including socioeconomic demographics, insurance, and travel distance to the treatment facility, persist as key barriers to receipt of BCT. Interventions that address these barriers may facilitate further uptake of BCT.

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