title: Treatment of ductal carcinoma in situ among patients cared for in large integrated health plans.
abstract: OBJECTIVE
  To examine whether use of adjuvant therapy varies by race/ethnicity among patients with ductal carcinoma in situ (DCIS) at 3 integrated health plan delivery sites based in California and Massachusetts.
  
  
  METHODS
  Cross-sectional study nested within a cohort of women diagnosed as having DCIS between 1990 and 2001.
  
  
  METHODS
  We reviewed medical records of 3000 non-Hispanic white (69%), black (10%), Hispanic (9%), and Asian or Pacific Islander (12%) women diagnosed as having DCIS between 1990 and 2001 and treated with breast-conserving therapy. chi(2) Test and multinomial logistic regression analysis were used to examine the association between race/ethnicity and use of adjuvant treatments after controlling for patient and clinical variables, including certain pathologic factors.
  
  
  RESULTS
  We found no significant differences in DCIS adjuvant treatment among racial/ethnic groups in bivariate or multinomial analyses after adjusting for demographic characteristics, comorbidity, and clinical factors. Minority women were as likely to undergo adjuvant radiation therapy as non-Hispanic white women. However, women 70 years or older (odds ratio, 0.40; 95% confidence interval, 0.31-0.51) and women who lived in areas with low geocoded median family income (odds ratio, 0.65; 95% confidence interval, 0.48-0.89) were less likely to receive adjuvant radiation therapy. Tumor size and comedo histologic growth pattern were associated with increased likelihood of receiving radiation therapy.
  
  
  CONCLUSIONS
  Use of adjuvant therapy by minority women in these managed care plans is similar to that by non-Hispanic white women, although use was less among older women and among women who lived in poorer neighborhoods.
authors.affiliation: Division of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 2nd Fl, Pasadena, CA 91101, USA. reina.haque@kp.org
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.forename: Ninah S
authors.initials: NS
authors.lastname: Achacoso
authors.forename: Suzanne W
authors.initials: SW
authors.lastname: Fletcher
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Laura C
authors.initials: LC
authors.lastname: Collins
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Schnitt
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Habel
mesh_terms: D000368:Aged; D002140:California; D044584:Carcinoma, Ductal / Q000208:ethnology / Q000532:radiotherapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000503:physiopathology; D008329:Managed Care Programs; D008404:Massachusetts; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians'
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