Identifying Disparities in Timely Receipt of Radiation After Breast-Conserving Surgery

Radiation therapy after breast-conserving surgery reduces local recurrence and improves survival. The new standard set forth by the Commission on Cancer (CoC) requires that radiation be initiated in less than or equal to 60 days of definitive surgery for patients receiving breast-conserving surgery for Stages I-III breast cancer who do not undergo adjuvant chemo or immunotherapy. Timely access to radiation is critical, and yet there still exists a modest number of patients who experience delays in the initiation of radiation. We aim to highlight this disparity at our institution and identify the socioeconomic factors that contribute to it.

Using the Breast Cancer Registry, we conducted a retrospective analysis of women diagnosed with Stages I-III breast cancer, who underwent breast-conserving surgery between 2011 and 2021. Women who received chemotherapy were excluded. We stratified patients based on socioeconomic and other factors and examined which factors attributed to an increased interval from surgery to initiation of radiation greater than the current standard of 60 days.

A cohort of 427 women meeting the inclusion criteria was identified. Most patients received adjuvant radiation within the new standard of 60 days from definitive surgery (72.4%). However, patients of White race were significantly more likely to receive adjuvant radiation within 60 days of final surgery (74.7%) compared to patients of Black race (55.6%). In addition, patients with private insurance or Medicare were more likely to receive adjuvant radiation within the current set standard (74.9% and 74.5%, respectively) in comparison to patients with Medicaid (50.0%).

This analysis identifies disparities in breast cancer treatment among minority populations at our institution. It also suggests that insurance status can affect the receipt of treatment in a recommended time frame. There is research that shows a delay in radiation impairs survival. These results indicate that improving access to timely adjuvant radiation may be leveraged to lessen disparities experienced by minority races regardless of insurance status.