Abstract
BackgroundLimited information is available about patterns of surgical management of early breast cancer by ethnicity of women in England, and any potential inequalities in the treatment received for breast cancer.MethodsNational Cancer Registration and Analysis Service data for women diagnosed with early invasive breast cancer (ICD–10 C50) during 2012–2017 were analysed. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95 per cent confidence intervals for the risk of mastectomy versus breast‐conserving surgery by ethnicity (black African, black Caribbean, Indian, Pakistani and white), adjusting for age, region, deprivation, year of diagnosis, co‐morbidity and stage at diagnosis.ResultsData from 164 143 women were included in the analysis. The proportion of women undergoing mastectomy fell by approximately 5 per cent between 2012 and 2017 across all the ethnic groups examined. In unadjusted analyses, each ethnic minority group had a significantly higher odds of mastectomy than white women; however, in the fully adjusted model, there were no significantly increased odds of having mastectomy for women of any ethnic minority group examined. For example, compared with white women, the unadjusted and fully adjusted ORs for mastectomy were 1·14 (95 per cent c.i. 1·05 to 1·20) and 1·04 (0·96 to 1·14) respectively for Indian women, and 1·45 (1·30 to 1·62) and 1·00 (0·89 to 1·13) for black African women. This attenuation in OR by ethnicity was largely due to adjustment for age and stage.ConclusionAllowing for different patterns of age and stage at presentation, the surgical management of early breast cancer is similar in all women, regardless of ethnicity.
Highlights
In the 2011 census in England and Wales[1, 86] per cent of the population was recorded as white, and 13 per cent as black, Asian or other minority groups
From 2012 to 2017 the proportion of missing ethnicity data fell to 5⋅5 per cent and, for this reason, the analyses presented here focus on data relating to women diagnosed with breast cancer during that time
When the main analyses were repeated for women with known values for all potential confounders, both the unadjusted and adjusted odds ratios (ORs) for mastectomy by ethnicity were similar to those based on the larger data set. These findings show that women in ethnic minority groups are more likely than white women to undergo mastectomy than breast-conserving surgery for breast cancer, but these differences are largely explained by differences in age and stage at presentation
Summary
In the 2011 census in England and Wales[1, 86] per cent of the population was recorded as white, and 13 per cent as black, Asian or other minority groups. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95 per cent confidence intervals for the risk of mastectomy versus breast-conserving surgery by ethnicity (black African, black Caribbean, Indian, Pakistani and white), adjusting for age, region, deprivation, year of diagnosis, co-morbidity and stage at diagnosis. Compared with white women, the unadjusted and fully adjusted ORs for mastectomy were 1⋅14 (95 per cent c.i. 1⋅05 to 1⋅20) and 1⋅04 (0⋅96 to 1⋅14) respectively for Indian women, and 1⋅45 (1⋅30 to 1⋅62) and 1⋅00 (0⋅89 to 1⋅13) for black African women. This attenuation in OR by ethnicity was largely due to adjustment for age and stage. Conclusion: Allowing for different patterns of age and stage at presentation, the surgical management of early breast cancer is similar in all women, regardless of ethnicity
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