title: Disparities in breast cancer treatment and survival for women with disabilities.
abstract: BACKGROUND
  Breast-conserving surgery combined with axillary lymph node dissection and radiotherapy or mastectomy are definitive treatments for women with early-stage breast cancer. Little is known about breast cancer treatment for women with disabilities.
  
  
  OBJECTIVE
  To compare initial treatment for early-stage breast cancer between women with and without disabilities and to examine the association of treatment differences and survival.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  11 Surveillance, Epidemiology, and End Results (SEER) Program tumor registries.
  
  
  METHODS
  100,311 women who received a diagnosis of stage I to IIIA breast cancer at 21 to 64 years of age from 1988 to 1999. Women who qualified for Social Security Disability Insurance (SSDI) and Medicare at breast cancer diagnosis were considered disabled.
  
  
  METHODS
  Receipt of breast-conserving surgery versus mastectomy. For women who had breast-conserving surgery (n = 49 166), the authors examined receipt of radiotherapy and axillary lymph node dissection. Survival was measured from diagnosis until death or until 31 December 2001.
  
  
  RESULTS
  Women with SSDI and Medicare coverage had lower rates of breast-conserving surgery than other women (43.2% vs. 49.2%; adjusted relative risk, 0.80 [95% CI, 0.76 to 0.84]). Among women who had breast-conserving surgery, women with SSDI and Medicare coverage were less likely than other women to receive radiotherapy (adjusted relative risk, 0.83 [CI, 0.77 to 0.90]) and axillary lymph node dissection (adjusted relative risk, 0.81 [CI, 0.74 to 0.90]). Women with SSDI and Medicare coverage had lower survival rates than those of other women in all-cause mortality (adjusted hazard ratio, 2.02 [CI, 1.88 to 2.16]) and breast cancer-specific mortality (adjusted hazard ratio, 1.31 [CI, 1.18 to 1.45]). Results were similar after adjustment for treatment differences.
  
  
  CONCLUSIONS
  Findings are limited to women who qualified for SSDI and Medicare. No data on adjuvant chemotherapy and hormonal therapy were available, and details about the underlying disability were lacking.
  
  
  CONCLUSIONS
  Women with disabilities had higher breast cancer mortality rates and were less likely to undergo standard therapy after breast-conserving surgery than other women. Differences in treatment did not explain the differences in breast cancer mortality rates.
authors.affiliation: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. emccarth@bidmc.harvard.edu
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roetzheim
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Chirikos
authors.forename: Donglin
authors.initials: D
authors.lastname: Li
authors.forename: Reed E
authors.initials: RE
authors.lastname: Drews
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D006278:Medicare; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018426:SEER Program; D012943:Social Security; D015996:Survival Rate; D014481:United States / Q000453:epidemiology