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Ethnic Disparities in Early Breast Cancer Management among Asian Americans and Pacific Islanders

Ethnic Disparities in Early Breast Cancer Management among Asian Americans and Pacific Islanders. Rebecca P. Gelber, MD, MPH Department of Medicine, University of Hawaii; Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Harvard Medical School.

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Ethnic Disparities in Early Breast Cancer Management among Asian Americans and Pacific Islanders

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  1. Ethnic Disparities in Early Breast Cancer Management among Asian Americans and Pacific Islanders Rebecca P. Gelber, MD, MPH Department of Medicine, University of Hawaii; Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Harvard Medical School

  2. Background • Standard treatment options for early breast cancer: • Breast-conserving surgery (BCS) • Radiation therapy following BCS • Chemotherapy for node-positive disease

  3. Background • Many women with early breast cancer do not receive standard treatment • Advanced age • Higher comorbidity • Rural residence • Lower socioeconomic status • Lack of health insurance • Non-white ethnicity

  4. Background • Few studies have addressed breast cancer management in Asian Americans and Pacific Islanders (AAPI) • Results are conflicting • Differences in presentation, survival for some ethnic groups

  5. Objective To examine association between patient ethnicity and treatment of early breast cancer in a cohort of AAPI women.

  6. Methods – Data Sources Linked data from: (1) Hawaii Tumor Registry • SEER (2) Healthcare claims • Largest health insurer in Hawaii • FFS, HMO, Medicare FFS • Treatment, comorbidity (3) 1990 Census tract data • Median household income

  7. Study Population • 2030 women • Stages I, II, IIIA breast cancer • Diagnosed 1995-2001 • Insured by BC/BS and had healthcare claims • White, Japanese, Chinese, Filipino, Hawaiian women

  8. Treatment Outcomes • BCS for primary resection • Radiation therapy following BCS • Adjuvant chemotherapy for node-positive disease

  9. Statistical Analysis • Logistic regression • Age • Tumor size, grade, nodal and receptor status • Income • Rural residence • Health plan type • Prior cancer history • Charlson comorbidity index • Year of diagnosis

  10. Patient characteristics by ethnicity (n=2030) *P<0.001

  11. Stage at diagnosis by ethnicity (n=2030) P<0.001

  12. Tumor characteristics by ethnicity (n=2030) *P<0.001

  13. Unadjusted treatment rates by ethnicity (n=2030) *P<0.05

  14. Adjusted odds ratios for treatment by ethnicity Ref = white

  15. Adjusted odds ratios for treatment by ethnicity Ref = white

  16. Adjusted odds ratios for treatment by ethnicity Ref = white

  17. Summary • All AAPI women, particularly Japanese and Filipinos, less likely to receive BCS • Filipinos may be less likely to receive radiation after BCS • Similar use of adjuvant chemotherapy

  18. Limitations • Residual confounding • Lack of information on patient preferences • Case selection • Power • Generalizability

  19. Strengths • Large number of AAPIs • Women <65 years • Linked registry and claims • More complete treatment estimates • Ability to examine chemotherapy • Assess comorbidity

  20. Conclusions • Ethnic disparities in the management of early breast cancer among AAPIs • Further study needed to determine reasons for these disparities and their impact on health outcomes

  21. Ellen P. McCarthy, PhD, MPH Dept. of Medicine, Beth Israel Deaconess Medical Center James W. Davis, PhD University of Hawaii; Blue Cross/Blue Shield of Hawaii Todd B. Seto, MD, MPH Dept. of Medicine, University of Hawaii

  22. BCS use by ethnicity (n=2030)

  23. Use of XRT after BCS, by ethnicity (n=1129)

  24. Use of CTX if LN+, by ethnicity (n=521)

  25. Odds ratios for BCS, according to ethnicity and income level

  26. Characteristics of women linked to claims

  27. BCS use: registry (n=3716) vs claims-supplemented (n=2030) data

  28. XRT after BCS: registry (n=3716) vs claims-supplemented (n=2030) data

  29. Patient characteristics (%) by ethnicity (n=2030) *P<0.05

  30. Patient characteristics by ethnicity (n=2030) *P<0.001

  31. Study Population • Exclusions • >1 prior non-breast cancer (n=52) • >1 breast tumor diagnosed on the same date (n=34) • ‘referred elsewhere, contraindicated, autopsy’ (n=26) • Missing tumor size (n=14) • Medicare-eligible in 1995-1996 (n=377)

  32. Study Population • 3339 eligible in tumor registry • 2030 (61%) successfully linked to claims • Younger • Higher income • Smaller tumors • Japanese more likely linked

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