title: Racial differences in definitive breast cancer therapy in older women: are they explained by the hospitals where patients undergo surgery?
abstract: BACKGROUND
  Prior research has documented racial disparities in patterns of care and outcomes for women with breast cancer.
  
  
  OBJECTIVE
  To assess whether black women receive care from lower-quality or lower-volume hospitals and if such differences explain disparities in receipt of definitive primary breast cancer therapy.
  
  
  METHODS
  Observational study of a population-based sample of breast cancer patients included in the SEER-Medicare database.
  
  
  METHODS
  Fifty five thousand four hundred seventy white or black women aged >65 diagnosed with stage I/II breast cancer during 1992-2002.
  
  
  METHODS
  Surgery at a high-quality hospital (top quartile rates of radiation after breast-conserving surgery) or high volume (top quartile) hospital and receipt of definitive primary therapy (mastectomy or breast-conserving surgery with radiation).
  
  
  RESULTS
  Black women were significantly less likely than white women to be treated at high-quality hospitals (adjusted odds ratio [OR] 0.60; 95% confidence interval [CI]: 0.40-0.87) but not high-volume hospitals (adjusted OR 0.85; 95% CI: 0.54-1.34). Black women were less likely than white women to receive definitive primary therapy, a finding partially explained by having surgery at a high-quality hospital but not by having surgery at a high-volume hospital.
  
  
  CONCLUSIONS
  Older black women were more likely than white women to undergo breast cancer surgery at hospitals with lower rates of radiation following breast-conserving surgery, and this explains some of the reported racial disparities previously observed in receipt of definitive therapy for early-stage breast cancer. Interventions to help hospitals treating large numbers of black women improve rates of radiation after breast-conserving surgery may help to decrease racial disparities in care.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, 180 Longwood Avenue, Boston, MA 02115, USA. keating@hcp.med.harvard.edu
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Elena
authors.initials: E
authors.lastname: Kouri
authors.forename: Yulei
authors.initials: Y
authors.lastname: He
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
mesh_terms: D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000532:radiotherapy / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006302:Health Services Research; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D018426:SEER Program; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*