title: Urban/rural residence moderates effect of race on receipt of surgery in patients with nonmetastatic breast cancer: a report from the South Carolina central cancer registry.
abstract: BACKGROUND
  Surgical resection is the cornerstone of therapy in patients with nonmetastatic breast cancer. Previous studies have reported underuse of adjuvant therapy among African Americans (AA). This study explores the independent effect of race on surgical resection in a recent, population-based sample of breast cancer patients.
  
  
  METHODS
  All cases of nonmetastatic breast cancer reported to the our state Cancer Registry between 1996 and 2002 were identified and linked to the state Inpatient/Outpatient Surgery Files and the 2000 Census. Characteristics between Caucasian and AA patients were compared using Student's t and chi-square tests. Odds ratios (OR) of resection and 95% confidence intervals (CI) were calculated using logistic regression.
  
  
  RESULTS
  We identified 12,404 Caucasian and 3,411 AA women. AA patients were more likely to be younger, non-married, have greater comorbidity, reside in rural communities, be less educated, live in poverty, and be uninsured or covered by Medicaid (all P < 0.0001). AA patients were slightly less likely to undergo resection compared to Caucasian patients (94.9% versus 96.4%, P < 0.0001). An interaction effect between race and urban/rural patient residence was observed (P = 0.003). After controlling for other factors, the adjusted OR for resection for urban AA patients was 0.58 (95% CI 0.41-0.82). In contrast, race had no effect on resection among rural patients (OR = 1.02; 95% CI 0.70-1.47).
  
  
  CONCLUSIONS
  AA race is an independent predictor of underuse of surgery among urban patients with breast cancer, while rural residence is associated with underuse of surgery, irrespective of race. Interventions designed to optimize surgical cancer care should target these vulnerable populations.
authors.affiliation: Department of Surgery, Medical University of South Carolina (MUSC), 25 Courtenay Drive - Suite 7018 (MSC 295), Charleston, SC 29425, USA. esnaolan@musc.edu
authors.forename: N F
authors.initials: NF
authors.lastname: Esnaola
authors.forename: K
authors.initials: K
authors.lastname: Knott
authors.forename: C
authors.initials: C
authors.lastname: Finney
authors.forename: M
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: M E
authors.initials: ME
authors.lastname: Ford
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000601:surgery*; D005260:Female; D005544:Forecasting; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012042:Registries; D012424:Rural Population; D013022:South Carolina / Q000453:epidemiology; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data