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Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased
Mary Ann Gilligan1, Ronald T Kneusel, Raymond G Hoffmann
1Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA. gilligan@mcw.edu
Background:
Use of breast-conserving treatment (BCT) has previously demonstrated variability by sociodemographic factors.
Objective:
To determine whether variation in use of BCT by age, race, county income, county education, and population density declined between 1983 and 1996.
Design:
Trends in use of BCT over time were modeled with logistic regression.
Setting:
Surveillance, Epidemiology, and End Results national tumor registry data.
Patients:
Population-based cohort of 158,496 women with local or regional stage breast cancer.
Main Outcome Measure:
Receipt of BCT.
Results:
Use of BCT increased overall, and among all subgroups of age, county income, county education, population density, and race. There was no decline in age-related variation in use of BCT over time. However, older women were less likely to undergo BCT including radiotherapy (RT) and lymph node dissection (LND), and were more likely to undergo BCT omitting RT and/or LND. Variation in use of BCT by county income persisted, with women residing in poorer counties less likely to undergo BCT, whether accompanied by RT and LND. Variation in overall use of BCT by county education also persisted. Although women residing in better-educated counties were more likely to undergo BCT accompanied by RT and LND, they were not more likely to undergo BCT omitting RT, LND, or both. No decline in variation by population density occurred, with women residing in urban areas more likely to use BCT whether accompanied by RT and LND.
Conclusions:
Sociodemographic differences in BCT use have persisted over time. The increased overall adoption of BCT has not led to consistency in use of this treatment.