Racial Differences in Utilization of Breast Conservation Surgery: Results from the National Cancer Data Base (NCDB).

Abstract

Whether rates of breast-conservation surgery (BCS) vary based on race and ethnicity has not been clearly elucidated on a national leve. The National Cancer Data Base (NCDB) was used to identify women who underwent surgery for invasive breast cancer during 2010 and 2011. The effect of race and ethnicity on BCS rates was determined, independent of patient demographics, tumor-related variables, and geographic region. There were 299,827 patients with known race and ethnicity who underwent definitive breast surgery. BCS rates by race were as follows: 135,065/241,236 (56.0%) for whites, 17,819/33,301 (53.5%) for blacks, 4,722/9,508 (49.7%) for Asian/Pacific Islanders, and 7,919/15,782 (50.2%) for Hispanics (p<0.001). Mean tumor size differed among the racial groups: 2.07cm in whites, 2.54cm in blacks, 2.23cm in Asians, and 2.48cm in Hispanics (p<0.001). When stratified by tumor size, BCS was most common in blacks and least common in Asians for all tumors >2cm (p<0.001). On multivariable analysis adjusted for age, tumor size, nodal status, grade, molecular type, geographic area, urban/rural residence, insurance status, and census-derived median income and education for the patient's zip code, the odds ratio for BCS for blacks compared to whites was 1.23 (95% confidence interval [CI] 1.20-1.27, p<0.001), for Asians was 0.84 (95% CI 0.80-0.88, p<0.001), and for Hispanics was 1.00 (95% CI 0.96-1.05, p=0.885). When adjusted for patient demographics, tumor-related variables, and geographic area, BCS rates are higher in blacks and lower in Asians compared to whites.