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BCT increasingly used, but barriers persist
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Utilization of breast-conserving therapy has increased during the past two decades, but barriers persist that limit its use, according to results of a retrospective, population-based study presented at the Breast Cancer Symposium.
Breast-conserving therapy (BCT) has been an established method of primary therapy for early-stage breast cancer since the early 1990s, yet many women continue to undergo mastectomy instead.
In the current study, researchers and colleagues strived to perform a comprehensive population-based review of the factors that influence the use of BCT.
“Our hypothesis was twofold,” Meeghan Lautner, MD, a breast cancer surgeon at The University of Texas San Antonio, said during a presentation. “First, that disparities in BCT utilization exist between different types of breast cancer treatment facilities, and second, that socioeconomic status — including education level, income and insurance status — are, in fact, predictors of BCT utilization.”
Meeghan Lautner
Lautner and colleagues used the National Cancer Database to identify 727,927 women with breast cancer (T1 or T2, any N) who underwent mastectomy or BCT between 1998 and 2011. The researchers assessed patient and facility variables that were associated with BCT, and they used logistic regression analysis to assess multivariate relationship between those variables and the likelihood patients would undergo BCT.
Researchers determined utilization of BCT increased from 54% in 1998 to 59% in 2006, then leveled off for the duration of the study period.
When researchers adjusted for clinical and demographic characteristics, they determined patients aged 52 to 61 years were more likely to undergo BCT than younger patients (OR=1.14; 95% CI, 1.12-1.15), and patients with the highest education levels were more likely to undergo BCT (OR=1.16; 95% CI, 1.14-1.19) than those with lower education levels.
Researchers reported higher BCT utilization rates among those with private insurance than those without insurance (OR=1.33; 95% CI, 1.28-1.38), as well as among those with the highest median income (OR=1.09; 95% CI, 1.06-1.11).
Results also showed BCT utilization rates were higher among those treated at academic cancer centers compared with community centers (OR=1.13; 95% CI, 1.11-1.15), patients who lived within 17 miles of a treatment facility compared with a farther distance (OR=1.25; 95% CI, 1.23-1.27), and patients treated in the Northeast compared with those treated in the South (OR=1.5; 95% CI, 1.48-1.52).
BCT utilization rates increased during the study period among patients of all age groups, as well as among those treated at community centers and among patients who live in the South. However, researchers determined disparities in BCT utilization persist due to income level, insurance status and distance to treatment facilities (≤17 miles vs. ≥18 miles).
“Significant gains have been made over the last 15 years in the use of BCT in the United States,” Lautner said. “Disparities based on age, geographic facility location and type of cancer treatment have lessened over time. Insurance type and travel distance remain persistently associated with underutilization of BCT, and annual income of less than $35,000 may be emerging as a new association with underutilization.”
The findings are valuable because they show how the treatment landscape has changed over time, according to researcher Isabelle Bedrosian, MD, associate professor of surgical oncology at The University of Texas MD Anderson Cancer Center.
“We hope this will help us understand where we are and are not making progress, as well as identify the barriers we need to overcome to create equity in the delivery of care for our patients,” Bedrosian said, adding the disparity based on insurance status is of particular interest. “Now with health care exchanges providing new insurance coverage options, will we rectify the disparity and overall increase BCT use?” Bedrosian said. “We will have to wait to see.”
For more information:
Lautner MA. Abstract #104. Presented at: Breast Cancer Symposium; Sept. 4-6, 2014; San Francisco.
Disclosure: The researchers report research funding and travel, accommodations or expenses from Elekta; consultant or advisory roles with Bayer and Gerson Lehrman Group and the MD Anderson Physician’s Network; and patents, royalties or other intellectual property from McGraw-Hill Publishing.