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Racial, ethnic disparities identified in breast cancer care
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SAN FRANCISCO — Despite established consensus, guidelines and treatment protocols, researchers observed racial and ethnic disparities in clinical presentation, treatment and outcomes, according to study findings.
The researchers examined the National Inpatient Sample to examine racial/ethnic disparities by stage of disease and comorbidities, postoperative complications and mortality, and surgical treatment allocation (breast-conserving surgery vs. mastectomy). The National Inpatient Sample, which includes data compiled from 44 states, represents 95% of all hospital discharges in the United States.
The researchers used the International Disease Codes to identify 75,100 patient discharges with primary diagnosis code of breast cancer and coincident procedure code for breast surgery from 2005 to 2009. They also acquired information about demographics, hospital characteristics, comorbidities, stage, surgical treatment, postoperative complications and inpatient death.
The investigators used multivariate logistic regression analyses to assess risk-adjusted association between race and patient outcomes.
Patient demographics included 58.3% white, 8.6% black, 5.7% Hispanic, 2.6% Asian and 24.8% identified as “other.”
Compared with whites, blacks were 1.3 times more likely to undergo breast-conserving surgery, and Hispanics were 1.2 times more likely to undergo breast-conserving surgery (P<.001 for both). Asians were less likely to undergo breast-conserving surgery (P<.01).
Blacks were 1.35 times more likely to develop postoperative complications (P<.001) and 1.87 times more likely to experience in-hospital mortality (P<.13).
Also, compared with whites, blacks were 1.17 times more likely to exhibit regional or metastatic disease (P<.001) and 1.58 times more likely to present with comorbidities (P<.003).
For more information:
Dehal A. Abstract #66. Presented at: 2012 Breast Cancer Symposium; Sept. 13-15, 2012; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.
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Krystyna D. Kiel, MD
We have seen these statistics repeatedly: On presentation, approximately three-fourths of patients will exhibit localized disease or regional disease, and a smaller proportion will have metastatic disease. In this inpatient sample, the numbers did not seem to vary across races. However, when you compare this data to the surveillance research from the American Cancer Society, there are several important differences. If you look at the ACS data, the number of patients with localized disease is actually smaller than observed in this study, the number of patients with regional disease is higher than seen in the study, and the number of patients with distant disease also was higher, so I’m not sure what this study represents.
According to the study, compared with white patients, black and Hispanic patients are more likely to exhibit regional or metastatic disease, but again many of these patients are presenting with comorbidities, which impact what kind of treatment they will receive.
An interesting conclusion of this study data is that there were more people who received breast-conserving surgery. I would like to point out that this is an inpatient sample. In our institution, about 95% of patients have breast-conserving surgery as outpatients. This is probably not representative of all patients, especially patients with comorbidities coming to the hospital. Regarding comorbidities, there is also a higher likelihood of developing complications. This may not represent all the breast surgeries we see in this country. Patients with greater morbidities may be admitted and may develop complications, and I’m not entirely sure that this study demonstrates disparities as its title suggested.
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