title: Variations in breast carcinoma treatment in older medicare beneficiaries: is it black or white.
abstract: BACKGROUND
  To evaluate associations between race and breast carcinoma treatment.
  
  
  METHODS
  Data from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3-4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources.
  
  
  RESULTS
  Sixty-seven percent of women received a mastectomy and 33% received breast-conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01-2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race-stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25-5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06).
  
  
  CONCLUSIONS
  Older black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within-stage race mortality disparities.
authors.affiliation: Department of Oncology, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC, USA. mandelbj@georgetown.edu
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.forename: Jon F
authors.initials: JF
authors.lastname: Kerner
authors.forename: Jack
authors.initials: J
authors.lastname: Hadley
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hwang
authors.forename: Lynne
authors.initials: L
authors.lastname: Eggert
authors.forename: Lenora E
authors.initials: LE
authors.lastname: Johnson
authors.forename: Karen
authors.initials: K
authors.lastname: Gold
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D002277:Carcinoma / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D006278:Medicare / Q000706:statistics & numerical data; D011287:Prejudice; D011787:Quality of Health Care; D014481:United States; D044465:White People