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Updated: Jan 17, 2026
Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis
Published on: February 6, 2020
Geospatial disparities, health system factors, and breast cancer care quality
Michael J Hassett1,2, Angela C Tramontano1, Hajime Uno2,3
1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.
Background:
Despite long-standing efforts to improve breast cancer care quality, wide performance gaps persist. We sought to identify regions demonstrating meaningfully low performance and characterize health-system and health-profession factors associated with geospatial disparities.
Methods:
We used the Surveillance, Epidemiology, and End Results-Medicare linked database and the Health Resources and Services Administration area health resource file to characterize performance across health-care service areas using 4 metrics: diagnosis stage, chemotherapy, radiation, and endocrine therapy. We used principal component analysis to identify health-care facility and provider characteristics associated with performance; and hierarchical multivariable modeling to attribute total variance proportionally to 5 domains: patient characteristics, health service area region, health-care facility and provider characteristics, randomness, and unexplained.
Results:
Among 31,571 women aged 66-79 diagnosed 2007-2013 with stage I-III breast cancer and treated with surgery, 61% had stage I disease, 23% received chemotherapy, 54% received radiation therapy, and 42% received endocrine therapy. Health system factors explained more variance for endocrine therapy (21%), chemotherapy (12%), and radiation therapy (12%), compared with geospatial region or patient characteristics. Health profession factors were associated with quality for stage, radiation therapy, and chemotherapy; health-care facility factors were associated with quality for stage, endocrine therapy, and chemotherapy. Patient characteristics explained <5% of observed variance.
Conclusions:
Reassuringly, only a small number of regions demonstrated suboptimal breast cancer care. Optimal performance was associated with multidisciplinary teams and facilities with robust resources and higher volumes. Incorporating geospatial and health system factors into quality measurement efforts could foster the design of impactful quality improvement programs.
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