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Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004-2009

Yeboa, Debra N. MD; Xu, Xiao PhD; Jones, Beth A. PhD, MPH; Soulos, Pamela MPH; Gross, Cary MD; Yu, James B. MD

American Journal of Clinical Oncology: December 2016 - Volume 39 - Issue 6 - p 568–574
doi: 10.1097/COC.0000000000000094
Original Articles: Breast

Objectives: Significant effort has been expended over the past decade to reduce racial disparities in breast cancer care. Whether disparities in receipt of appropriate radiotherapy care for breast cancer persisted despite these efforts is unknown, as is the impact of being eligible for Medicare. We therefore investigated trends in racial differences by age in postbreast lumpectomy radiation therapy (PLRT) from 2004 to 2009.

Materials and Methods: We analyzed the Surveillance, Epidemiology and End Results registry database for women aged 40 to 85 years who underwent lumpectomy for stage I breast cancer and were eligible for PLRT. We examined variables potentially associated with the receipt of PLRT, including year of diagnosis, race, and examined women separately by age group.

Results: Among 67,124 women aged 40 to 85 years undergoing lumpectomy, receipt of PLRT decreased from 80.7% in 2004 to 76.8% by 2009 (P<0.001). There remained a persistent disparity in PLRT among African American women (in 2004, 80.6% white vs. 78.9% African American and in 2009, 77.5% white vs. 72.0% African American). In multivariable logistic regression, African American race (odds ratio [OR], 0.82; 95% confidence interval [CI]. 0.76-0.89) and being diagnosed more recently were associated with lower odds of PLRT (OR for 2009 vs. 2004: 0.74; 95% CI, 0.69-0.79), whereas older women typically covered by public health insurance (aged 65 to 69 y) were more likely to receive PLRT (OR, 1.09; 95% CI, 1.02-1.15).

Conclusions: PLRT decreased by a significant percentage of 3.9% among all women in recent years, and racial disparities in PLRT receipt have persisted. Medicare eligibility increased the likelihood of PLRT receipt.

Departments of *Therapeutic Radiology (Radiation Oncology), Smilow Cancer Center, Yale School of Medicine

Obstetrics, Gynecology, and Reproductive Sciences

Medicine, Yale School of Medicine

§School of Public Health, Yale University

Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT

J.B.Y. received 21st Century Oncology research grant; C.G. received Medtronic, 21st Century Oncology research grant and is a FairHealth advisory board member. The remaining authors declare no conflicts of interest.

Reprints: Debra N. Yeboa, MD, Department of Therapeutic Radiology (Radiation Oncology), Smilow Cancer Center, Yale-New Haven Hospital, Yale School of Medicine, 20 York Street, New Haven, CT 06511. E-mail: debra.yeboa@yale.edu.

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