Racial differences in treatment for breast cancer among black and white women in Atlanta

Abstract

603 Background: Among women with breast cancer, Black women experience a disproportionate excess in mortality, a reflection of their marked poorer survival, which persists even within stage and age groups. Adherence to first course treatment guidelines for breast cancer may not be uniform across racial/ethnic groups and could be a major contributing factor to racial disparities in outcome. In this population-based study, we assessed racial differences in initial treatment of primary invasive breast cancer. Methods: All data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. The study population included all invasive breast cancers diagnosed during 2000–2001 among Black (n=877) and White (n=2437) female residents of the five Atlanta SEER counties, an area whose population is 36% Black and where several large teaching hospitals are located. Outcome factors included delay in first course treatment, type of treatment, performance of cancer directed surgery, type of surgery, and receipt of chemotherapy, radiotherapy, or hormonal therapy. Racial differences in treatment were analyzed according to their basis for treatment; stage or age at diagnosis and tumor factors. Analyses utilized frequency distributions, χ2 tests of independence, and Cochran-Mantel-Haenszel statistics in and across strata. Results: Black women were more likely to experience delays in treatment, regardless of stage at diagnosis, and 4–5 fold more likely to experience delays greater than 60 days (p<0.001). For local-regional disease, more Black women did not receive cancer directed surgery (14.2% vs. 2.9% of white women, p<0.001), but did receive breast conserving surgery (BCS) equivalently. However, only 61% of Black vs. 72% of White women received radiation with BCS (p<0.001). Black women eligible for hormonal therapy were less likely to receive it (p<0.001). Conclusions: Our findings suggest treatment standards are not adequately or equivalently implemented among Black and White women, even in a metropolitan area where teaching hospitals provide a substantial portion of breast cancer care. Treatment differences can adversely affect outcome and reasons for the differences need to be addressed. No significant financial relationships to disclose.