In terms of early-stage breast cancer treatment, disparities in outcome based on treatment procedure can derive from socio-economic factors rather than medical reasons, according to a study from the laboratory of Isabelle Bedrosian, MD, at MD Anderson Cancer Center. Women who opted for breast conserving therapy (BCT) rather than mastectomy, largely due to access of care, have a slightly better five-year survival rate than those who choose mastectomy, according to another study from Dr. Bedrosian’s laboratory. The disparity in treatment poses a hazard for women who receive the inferior treatment.
Dr. Bedrosian’s laboratory previously identified BCT as offering a greater survival advantage over mastectomy for women with early stage, hormone-receptor positive disease. Yet despite this evidence, a large number of women continue to be treated via mastectomy. The research team at MD Anderson investigated why, and Meeghan Lautner, MD, a former fellow at MD, will present the findings at the 2014 Breast Cancer Symposium.
“What’s particularly novel and most meaningful about our study is that we looked at how the landscape has changed over time,” said Dr. Bedrosian in a news release from MD Anderson. The team analyzed data from the National Cancer Database–which is an outcomes registry of three societies that reports approximately 70% of newly-diagnosed cancer cases in the United States–for a period spanning from 1998 to 2011. More than 700,000 cases of early-stage breast cancer were associated with either BCT or mastectomy.
It was encouraging to see the rates of BCT increased from 54% in 1998 to 59% in 2006, but they stabilized beyond that point. Demographic and clinical characteristics were clearly associated with which treatment was pursued. The typical BCT patient was between the ages of 52 and 61, had obtained higher-level education, received a median income, enrolled in private insurance (versus uninsured), and was treated at academic medical centers rather than community medical centers.
Since much has changed since 2011, it would be interesting to analyze more recent data. “Now with healthcare exchanges providing new insurance coverage options, will we rectify the disparity and overall increase BCT use?” asked Dr. Bedrosian. “We will have to wait to see.”
What is known is that from 1998 to 2011, BCT usage increased across all demographic and clinical characteristics, but disparities still exist in terms of insurance, income, and ease of accessing a treatment facility. In the study, women who lived within 17 miles of a care center were more likely to undergo BCT, as were women who lived higher in the Northeast than in the South.
Now that the disparities are more evident, it is important to address the inequalities in treatment. Although physicians and the medical community have already largely equalized in geographic distribution, factors such as insurance type, income, and education continue to contribute to the disparity in treatment. “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,” concluded Dr. Bedrosian.
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