Abstract MS3-1: The Role of Providers in Breast Cancer Disparities

Abstract

Abstract Recent research suggests that racial disparities in health care may be driven in part by differences in where minority patients seek care. Minority patients are more likely to receive care in lower performing hospitals and to be treated by physicians that are less well trained and have less access to important clinical resources than those treating white patients. We analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare to understand more about the influence of providers on care for older women with early-stage breast cancer. In a first analysis, we assessed the hospitals where white and black women with early-stage breast cancer received care. We observed that a small number of hospitals treated the majority of black patients (e.g., 81% of black patients had surgery at 82 of the 481 (17%) hospitals). We found that black women were more likely than white women to undergo breast cancer surgery at hospitals with lower rates of radiation following breast-conserving surgery. This difference in site of surgery explains some of the racial disparities in receipt of definitive primary therapy for early-stage breast cancer. In a second set of analyses, we assessed the role of distance, hospital racial composition, hospital safety net status, and other hospital characteristics on patient's choice of hospital. Preliminary analyses suggest that proximity to certain hospitals explains only a portion of the greater distribution of black breast cancer patients in lower-quality hospitals. Black women with breast cancer appear to seek care in hospitals that also care for greater numbers of black patients with other medical conditions. Additional analyses are exploring the influence of other hospital characteristics on choice of hospital. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr MS3-1.