title: Racial Differences in Utilization of Breast Conservation Surgery: Results from the National Cancer Data Base (NCDB).
abstract: Whether rates of breast-conservation surgery (BCS) vary based on race and ethnicity has not been clearly elucidated on a national leve.
  
  
  
  The National Cancer Data Base (NCDB) was used to identify women who underwent surgery for invasive breast cancer during 2010 and 2011. The effect of race and ethnicity on BCS rates was determined, independent of patient demographics, tumor-related variables, and geographic region.
  
  
  
  There were 299,827 patients with known race and ethnicity who underwent definitive breast surgery. BCS rates by race were as follows: 135,065/241,236 (56.0 %) for whites, 17,819/33,301 (53.5 %) for blacks, 4,722/9,508 (49.7 %) for Asian/Pacific Islanders, and 7,919/15,782 (50.2 %) for Hispanics (p < 0.001). Mean tumor size differed among the racial groups: 2.07 cm in whites, 2.54 cm in blacks, 2.23 cm in Asians, and 2.48 cm in Hispanics (p < 0.001). When stratified by tumor size, BCS was most common in blacks and least common in Asians for all tumors >2 cm (p < 0.001). On multivariable analysis adjusted for age, tumor size, nodal status, grade, molecular type, geographic area, urban/rural residence, insurance status, and census-derived median income and education for the patient's zip code, the odds ratio for BCS for blacks compared to whites was 1.23 (95 % confidence interval [CI] 1.20-1.27, p < 0.001), for Asians was 0.84 (95 % CI 0.80-0.88, p < 0.001), and for Hispanics was 1.00 (95 % CI 0.96-1.05, p = 0.885).
  
  
  
  When adjusted for patient demographics, tumor-related variables, and geographic area, BCS rates are higher in blacks and lower in Asians compared to whites.
authors: Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
authors: Princess
authors: P
authors: Thomas
authors: Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
authors: Brigid K
authors: BK
authors: Killelea
authors: Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
authors: Nina
authors: N
authors: Horowitz
authors: Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
authors: Anees B
authors: AB
authors: Chagpar
authors: Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA. donald.lannin@yale.edu.
authors: Donald R
authors: DR
authors: Lannin
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D020360:Neoadjuvant Therapy; D044382:Population Groups / Q000706:statistics & numerical data*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D047368:Tumor Burden; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human