title: Racial variation in breast cancer treatment among Department of Defense beneficiaries.
abstract: BACKGROUND
  Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system.
  
  
  METHODS
  The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy.
  
  
  RESULTS
  There was no significant difference in surgery type, particularly when mastectomy was compared with breast-conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8-1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9-1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6-1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2-0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3-0.8).
  
  
  CONCLUSIONS
  Even within an equal access health care system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted.
authors.affiliation: United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC, USA. Lindsey.Enewold@us.army.mil
authors.forename: Lindsey
authors.initials: L
authors.lastname: Enewold
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.forename: William F
authors.initials: WF
authors.lastname: Anderson
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.forename: Shelia H
authors.initials: SH
authors.lastname: Zahm
authors.forename: Kangmin
authors.initials: K
authors.lastname: Zhu
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D018931:Antineoplastic Agents, Hormonal