title: Disparities in the use of radiation therapy in patients with local-regionally advanced breast cancer.
abstract: BACKGROUND
  Radiation therapy (RT) is indicated for the treatment of local-regionally advanced breast cancer (BCa).
  
  
  OBJECTIVE
  We hypothesized that black and Hispanic patients with local-regionally advanced BCa would receive lower rates of RT than their white counterparts.
  
  
  METHODS
  The Surveillance Epidemiology and End Results database was used to identify white, black, Hispanic, and Asian patients with invasive BCa and ≥10 metastatic lymph nodes diagnosed between 1988 and 2005. Univariate and multivariate logistic regression evaluated the relationship of race/ethnicity with use of RT. Multivariate models stratified for those undergoing mastectomy or lumpectomy.
  
  
  RESULTS
  Entry criteria were met by 12,653 patients. Approximately half of the patients did not receive RT. Most patients were white (72%); the remainder were Hispanic (10.4%), black (10.3%), and Asian (7.3%). On univariate analysis, Hispanics (odd ratio [OR] 0.89; 95% confidence interval [CI], 0.79-1.00) and blacks (OR 0.79; 95% CI, 0.70-0.89) were less likely to receive RT than whites. On multivariate analysis, blacks (OR 0.76; 95% CI, 0.67-0.86) and Hispanics (OR 0.80; 95% CI, 0.70-0.90) were less likely than whites to receive RT. Disparities persisted for blacks (OR 0.74; 95% CI, 0.64-0.85) and Hispanics (OR 0.77; 95% CI, 0.67-0.89) who received mastectomy, but not for those who received lumpectomy.
  
  
  CONCLUSIONS
  Many patients with local-regionally advanced BCa do not receive RT. Blacks and Hispanics were less likely than whites to receive RT. This disparity was noted predominately in patients who received mastectomy. Future efforts at improving rates of RT are warranted. Efforts at eliminating racial/ethnic disparities should focus on black and Hispanic candidates for postmastectomy RT.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, CA, USA. steve.martinez@ucdmc.ucdavis.edu
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Shannon H
authors.initials: SH
authors.lastname: Beal
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
authors.forename: Vijay P
authors.initials: VP
authors.lastname: Khatri
authors.forename: Allen
authors.initials: A
authors.lastname: Chen
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000737:chemistry / Q000208:ethnology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D011878:Radiotherapy / Q000706:statistics & numerical data; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D012044:Regression Analysis; D018426:SEER Program; D014481:United States / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone