title: Socioeconomic and racial disparities in the selection of chest wall boost radiation therapy in californian women after mastectomy.
abstract: To better elucidate the socioeconomic and racial differences in women who received postmastectomy radiation therapy with or without a chest wall boost, the records from 4747 women included in the California Cancer Registry were reviewed. Poor and Hispanic women were more likely to receive a chest wall boost than were more affluent and non-Hispanic women.
  
  
  BACKGROUND
  Healthcare disparities in breast cancer treatment have been well documented. We investigated the socioeconomic status (SES) and racial factors in women with locally advanced breast cancer from the California Cancer Registry who had received postmastectomy radiation therapy (PMRT) with or without a chest wall boost (CWB).
  
  
  METHODS
  The records of 4747 women with invasive breast cancer, diagnosed from 2005 to 2009, who had undergone PMRT, were reviewed and stratified by treatment with (n = 2686 [57%]) or without (n = 2061 [43%]) a CWB. Various patient demographic and biologic factors were analyzed using univariate and multivariate analysis.
  
  
  RESULTS
  Receipt of a CWB was associated with race/ethnicity (P < .001), SES (P < .001), tumor size (P = .038), tumor grade (P = .033), human epidermal growth factor 2 (HER2) status (P = .015), American Joint Committee on Cancer stage (P = .001), number of nodes examined (P = .001), and number of positive nodes (P = .037) on univariate analysis. After controlling for confounding factors, race/ethnicity and SES remained independently predictive of a CWB. Hispanic women were more likely to receive a CWB than Asian (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.60-0.90), black (HR, 0.63; 95% CI, 0.48-0.83), or white (HR, 0.81; 95% CI, 0.69-0.95) women. Also, women of low SES were more likely to receive a CWB than women of high SES (HR, 0.74; 95% CI, 0.64-0.86).
  
  
  CONCLUSIONS
  We found that poor and Hispanic women were more commonly treated with a CWB than were more affluent and non-Hispanic women with a similar cancer stage, cancer biology, and treatment paradigm.
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Clayton
authors.initials: C
authors.lastname: Hess
authors.affiliation: Mercer University School of Medicine, Macon, GA.
authors.forename: Anna
authors.initials: A
authors.lastname: Lee
authors.affiliation: Public Health Institute, Cancer Registry of Greater California, Sacramento, CA.
authors.forename: Kari
authors.initials: K
authors.lastname: Fish
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Megan
authors.initials: M
authors.lastname: Daly
authors.affiliation: Public Health Institute, Cancer Registry of Greater California, Sacramento, CA; Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, CA.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA. Electronic address: jyoti.mayadev@ucdmc.ucdavis.edu.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Mayadev
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002140:California / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D018579:Patient Selection; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018426:SEER Program; D012959:Socioeconomic Factors; D035441:Thoracic Wall
keywords: Breast cancer; Healthcare disparities; Hispanic ethnicity; Minority populations; Postmastectomy radiation therapy