Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption. Med Care 2002 Mar;40(3):181-9
Date
03/07/2002Pubmed ID
11880791DOI
10.1097/00005650-200203000-00002Scopus ID
2-s2.0-0036512513 (requires institutional sign-in at Scopus site) 91 CitationsAbstract
BACKGROUND: Use of breast-conserving treatment (BCT) has previously demonstrated variability by sociodemographic factors.
OBJECTIVE: To determine whether variation in use of BCT by age, race, county income, county education, and population density declined between 1983 and 1996.
DESIGN: Trends in use of BCT over time were modeled with logistic regression.
SETTING: Surveillance, Epidemiology, and End Results national tumor registry data.
PATIENTS: Population-based cohort of 158,496 women with local or regional stage breast cancer.
MAIN OUTCOME MEASURE: Receipt of BCT.
RESULTS: Use of BCT increased overall, and among all subgroups of age, county income, county education, population density, and race. There was no decline in age-related variation in use of BCT over time. However, older women were less likely to undergo BCT including radiotherapy (RT) and lymph node dissection (LND), and were more likely to undergo BCT omitting RT and/or LND. Variation in use of BCT by county income persisted, with women residing in poorer counties less likely to undergo BCT, whether accompanied by RT and LND. Variation in overall use of BCT by county education also persisted. Although women residing in better-educated counties were more likely to undergo BCT accompanied by RT and LND, they were not more likely to undergo BCT omitting RT, LND, or both. No decline in variation by population density occurred, with women residing in urban areas more likely to use BCT whether accompanied by RT and LND.
CONCLUSIONS: Sociodemographic differences in BCT use have persisted over time. The increased overall adoption of BCT has not led to consistency in use of this treatment.
Author List
Gilligan MA, Kneusel RT, Hoffmann RG, Greer AL, Nattinger ABAuthor
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAge Factors
Aged
Breast Neoplasms
Cohort Studies
Educational Status
Female
Health Services Research
Humans
Logistic Models
Lymph Node Excision
Mastectomy, Segmental
Middle Aged
Patient Acceptance of Health Care
Population Density
Practice Patterns, Physicians'
Radiotherapy, Adjuvant
Socioeconomic Factors
United States
