TitleRacial disparities in early stage breast cancer treatment
NameGeorge, Prethibha A. (author), DEMISSIE, KITAW (chair), RHOADS, GEORGE (internal member), LIN, YONG (internal member), West, Bernadette (internal member), Hirshfield, Kim (outside member), Azu, Michelle (outside member), Rutgers University, Graduate School - New Brunswick,
African American women--Health and hygiene,
Women, White--Health and hygiene,
African American women--Medical care,
Discrimination in medical care--United States
DescriptionIntroduction: Appropriate treatment disparity and delay in receipt of treatment are possible reasons that contribute to shorter survival in African-American (AA) breast cancer patients compared to their White counterparts. Specific Aims: In early stage breast cancer: 1) determine if racial differences exist in treatment, 2) examine racial disparity of delays in diagnosis and treatment initiation and explore factors that predicted delay in the overall population and by race, 3) examine factors that influenced the choice between mastectomy and breast-conserving surgery (BCS) and whether these factors differed by race. Methods: Newly diagnosed invasive breast cancer patients during 2005-2010 were identified in seven eastern New Jersey counties through rapid case ascertainment. For each AA woman 18-85 years of age, a white woman was randomly selected (± 5 years of age and from same county). Two data collection methods took place: medical chart review (Aims 1 & 2) and semi-structured interviews (Aim 3). Multivariable binomial and linear regression models were conducted to explore associations between race and outcomes (receipt of standard treatment; diagnosis and treatment delay). Results: In Aim 1, AAs tended not to receive optimal treatment compared to whites (RR: 1.60; 95% CI: .94, 2.71). Aim 2 demonstrated that AA women experienced longer time to diagnosis and surgical treatment. The geometric mean (95% CI) for whites and AAs in time to diagnosis was 35 (31, 40) and 47 (41, 54); time to surgery was 28 (26, 30) and 33 (30, 35) respectively. Aim 3 demonstrated that health issues that interfered with physical/social activities influenced AAs to receive mastectomy compared to BCS (RR: 1.68; 95% CI: 1.01, 2.77). Conclusion: We observed racial differences in receipt of optimal treatment (after controlling clinical factors) and took longer time to diagnosis and treatment for early stage breast cancer among AAs compared to white women. These differences could contribute to the observed poor survival in AAs with breast cancer. Also AAs listed previous health issues as an influencing factor in the surgical treatment they received. The findings suggest that interventions are needed to eliminate barriers that contribute to the observed disparity and to help narrow the racial gap in survival rates.
NoteIncludes bibliographical references
Noteby Prethibha A. George
CollectionGraduate School - New Brunswick Electronic Theses and Dissertations
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.