Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study.
BACKGROUND
In prior studies, the use of standard breast cancer treatments has varied by race, but previous analyses were not nationally representative. Therefore, in a comprehensive, national cohort of Medicare patients, racial disparities in the use of radiotherapy (RT) after breast-conserving surgery (BCS) for invasive breast cancer were quantified.


METHODS
A national Medicare database was used to identify all beneficiaries (age >65 years) treated with BCS for incident invasive breast cancer in 2003. Claims codes identified RT use, and Medicare demographic data indicated race. Logistic regression modeled RT use in white, black, and other-race patients, adjusted for demographic, clinical, and socioeconomic covariates.


RESULTS
Of 34,080 women, 91% were white, 6% were black, and 3% were another race. The mean age of the patients was 76 +/- 7 years. Approximately 74% of whites, 65% of blacks, and 66% of other-race patients received RT (P < .001). After covariate adjustment, whites were found to be significantly more likely to receive RT than blacks (odds ratio, 1.48; 95% confidence interval, 1.34-1.63 [P < .001]). Disparities between white and black patients varied by geographic region, with blacks in areas of the northeastern and southern United States demonstrating the lowest rates of RT use (57% in these regions). In patients age <70 years, racial disparities persisted. Specifically, 83% of whites, 73% of blacks, and 78% of other races in this younger group received RT (P < .001).


CONCLUSIONS
In this comprehensive national sample of older breast cancer patients, substantial racial disparities were identified in RT use after BCS across much of the United States. Efforts to improve breast cancer care require overcoming these disparities, which exist on a national scale.
Smith
Grace L
GL
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Shih
Ya-Chen T
YC
Xu
Ying
Y
Giordano
Sharon H
SH
Smith
Benjamin D
BD
Perkins
George H
GH
Tereffe
Welela
W
Woodward
Wendy A
WA
Buchholz
Thomas A
TA
D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015412:Mastectomy, Segmental; D006278:Medicare; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D014481:United States; D044465:White People