Cancer: Socioeconomics do not explain breast cancer disparities

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The modest association between black versus white race and guideline-recommended breast cancer care is insensitive to adjustment for insurance and area-level socioeconomic status, found a study published online Oct. 11 in Cancer.

“Previous studies have demonstrated less recommended breast cancer care for black and Hispanic women versus white women… and mortality differences by race have widened over time,” offered lead author Rachel A. Freedman, MD, of Harvard Medical School and the Dana Farber Cancer Institute in Boston, and her colleagues. Noting that both socioeconomic status and insurance have been cited to explain observed racial disparities in care, data are limited on the independent contributions of these factors to the receipt of appropriate breast cancer treatments.

The researchers sought to observe care for a national cohort of breast cancer patients, to assess whether insurance and socioeconomic status were associated with racial differences in care by including 86 percent white women, 10 percent African-American women and 4 percent Hispanic women diagnosed with invasive breast cancer from 1998 to 2005 at National Cancer Data Base hospitals.

Multivariate logistic regression was used to assess the probability of definitive locoregional therapy, hormone receptor testing and adjuvant systemic therapy among the patient cohort. Additionally, insurance and area-level socioeconomic status was included to determine whether these variables were associated with observed racial/ethnic disparities, explained the authors.

Freedman and colleagues determined that a majority of the women included in the study had private insurance (51 percent) or Medicare (41 percent). Among eligible patients, 80 percent with stage I/II cancer had undergone definitive locoregional therapy, 98.5 percent with stage I-IV disease had hormone receptor testing and 53.1 percent and 50.2 percent with stage I-III disease received adjuvant hormonal therapy and chemotherapy, respectively.

Compared with white women, black and Hispanic women had lower rates of definitive locoregional therapy and adjuvant hormonal therapy and higher rates of chemotherapy.  Specifically, black women had 0.91 times lower odds of receiving recommended local therapy, 0.90 times lower odds of receiving hormonal therapy and 0.87 times lower odds of receiving chemotherapy than white women. However, all groups had high rates of hormone receptor testing, the researchers offered.  

After adjustment for insurance and socioeconomic status, racial disparities were still found to persist, “despite efforts to eliminate disparities in cancer care in recent years,” the authors noted.   

The findings of the study call for “multifaceted efforts to better understand disparities, ensure receipt of effective treatments and improve outcomes in women with potentially curable disease,” concluded Freeman and colleagues.