Variations in breast carcinoma treatment in older medicare beneficiaries

Is it black and white?

Jeanne S. Mandelblatt, Jon F. Kerner, Jack Hadley, Yi Ting Hwang, Myra L Eggert, Lenora E. Johnson, Karen Gold

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

BACKGROUND. To evaluate associations between race and breast carcinoma treatment. METHODS. Data from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3-4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources. RESULTS. Sixty-seven percent of women received a mastectomy and 33% received breast-conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01-2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race-stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25-5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06). CONCLUSIONS. Older black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within-stage race mortality disparities.

Original languageEnglish (US)
Pages (from-to)1401-1414
Number of pages14
JournalCancer
Volume95
Issue number7
DOIs
StatePublished - Oct 1 2002
Externally publishedYes

Fingerprint

Medicare
Ageism
Breast Neoplasms
Radiation
Mastectomy
Therapeutics
Confidence Intervals
Delivery of Health Care
Racism
Segmental Mastectomy
Health Resources
Poverty
hydroquinone
Comorbidity
Breast
Mortality
Neoplasms

Keywords

  • Breast carcinoma
  • Elderly
  • Health Services Research
  • Race
  • Treatment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mandelblatt, J. S., Kerner, J. F., Hadley, J., Hwang, Y. T., Eggert, M. L., Johnson, L. E., & Gold, K. (2002). Variations in breast carcinoma treatment in older medicare beneficiaries: Is it black and white? Cancer, 95(7), 1401-1414. https://doi.org/10.1002/cncr.10825

Variations in breast carcinoma treatment in older medicare beneficiaries : Is it black and white? / Mandelblatt, Jeanne S.; Kerner, Jon F.; Hadley, Jack; Hwang, Yi Ting; Eggert, Myra L; Johnson, Lenora E.; Gold, Karen.

In: Cancer, Vol. 95, No. 7, 01.10.2002, p. 1401-1414.

Research output: Contribution to journalArticle

Mandelblatt, JS, Kerner, JF, Hadley, J, Hwang, YT, Eggert, ML, Johnson, LE & Gold, K 2002, 'Variations in breast carcinoma treatment in older medicare beneficiaries: Is it black and white?', Cancer, vol. 95, no. 7, pp. 1401-1414. https://doi.org/10.1002/cncr.10825
Mandelblatt, Jeanne S. ; Kerner, Jon F. ; Hadley, Jack ; Hwang, Yi Ting ; Eggert, Myra L ; Johnson, Lenora E. ; Gold, Karen. / Variations in breast carcinoma treatment in older medicare beneficiaries : Is it black and white?. In: Cancer. 2002 ; Vol. 95, No. 7. pp. 1401-1414.
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abstract = "BACKGROUND. To evaluate associations between race and breast carcinoma treatment. METHODS. Data from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3-4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources. RESULTS. Sixty-seven percent of women received a mastectomy and 33{\%} received breast-conserving surgery. The odds of radiation omission were 48{\%} higher (95{\%} confidence interval [CI] 1.01-2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11{\%}). In race-stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95{\%} CI 1.25-5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06). CONCLUSIONS. Older black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within-stage race mortality disparities.",
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AU - Mandelblatt, Jeanne S.

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AU - Hadley, Jack

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AU - Eggert, Myra L

AU - Johnson, Lenora E.

AU - Gold, Karen

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N2 - BACKGROUND. To evaluate associations between race and breast carcinoma treatment. METHODS. Data from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3-4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources. RESULTS. Sixty-seven percent of women received a mastectomy and 33% received breast-conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01-2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race-stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25-5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06). CONCLUSIONS. Older black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within-stage race mortality disparities.

AB - BACKGROUND. To evaluate associations between race and breast carcinoma treatment. METHODS. Data from 984 black and 849 white Medicare beneficiaries 67 years or older with local breast carcinoma and a subset of 732 surviving women interviewed 3-4 years posttreatment were used to calculate adjusted odds of treatment, controlling for age, comorbidity, attitudes, region, and area measures of socioeconomic and health care resources. RESULTS. Sixty-seven percent of women received a mastectomy and 33% received breast-conserving surgery. The odds of radiation omission were 48% higher (95% confidence interval [CI] 1.01-2.19) for blacks than for whites after considering covariates, but the absolute number of women who failed to receive this modality was small (11%). In race-stratified models, the odds of having radiation omitted were significantly higher among blacks living greater distances from a cancer center (vs. lesser) or living in areas with high poverty (vs. low), but these factors did not affect radiation use among whites. Among those interviewed, blacks reported perceiving more ageism and racism in the health care system than whites (P = 0.001). The independent odds of receiving mastectomy (vs. breast conservation and radiation) were 2.72 times higher (95% CI 1.25-5.92) among women reporting the highest quartile of perceived ageism scores, compared with the lowest, and higher perceived ageism tended to be associated with higher odds of radiation omission (P = 0.06). CONCLUSIONS. Older black women with localized breast carcinoma may have a different experience obtaining treatment than their white counterparts. The absolute number of women receiving nonstandard care was small and the effects were small to moderate. However, if these patterns persist, it will be important to evaluate whether such experiences contribute to within-stage race mortality disparities.

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KW - Elderly

KW - Health Services Research

KW - Race

KW - Treatment

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