TY - JOUR
T1 - Patterns of care with regard to surgical choice and application of adjuvant radiation therapy for preinvasive and early stage breast cancer in rural appalachia
AU - Freeman, Andrew B.
AU - Huang, Bin
AU - Dragun, Anthony E.
PY - 2012/8
Y1 - 2012/8
N2 - Background: Many disparities exist in treatment of early stage breast cancer. Our objective was to conduct a cross-sectional registry analysis of women with early stage breast cancer in Appalachian Kentucky to identify factors affecting surgical choice [breast conserving surgery (BCS) vs mastectomy] and appropriate use of adjuvant radiation therapy (RT). Methods: Database collection was done through the Kentucky Cancer Registry. Inclusion criteria included female breast cancer patients diagnosed between 1998 and 2007. Patients were diagnosed with ductal carcinoma in situ or American Joint Committee on Cancer stage I or II disease. Database search was limited to Appalachian residents. Statistical analyses were carried out to identify variables affecting surgical choice, receipt of RT, and survival. Results: Analysis evaluated 5,541 Appalachian patients. The distribution of surgery favored BCS (54.1%) over mastectomy (45.9%). On multivariate analysis, the most significant factors for mastectomy were advanced stage [odds ratio (OR) 2.571, P<0.0001], rural location (OR 2.075, P<0.0001), and insurance status (OR 1.546, P<0.0001). Of patients choosing BCS, 56.2% received adjuvant RT. On multivariate analysis age >70 years (OR 2.506, P<0.0001), rural location (OR 2.416, P<0.0001), and lack of insurance (OR 1.651, P=0.0168) were the strongest predictors for not receiving adjuvant RT. Conclusions: Mastectomy rate remains higher and the rate of RT after BCS is lower in Appalachian women compared with other contemporary studies of women with ductal carcinoma in situ and early stage breast cancer.
AB - Background: Many disparities exist in treatment of early stage breast cancer. Our objective was to conduct a cross-sectional registry analysis of women with early stage breast cancer in Appalachian Kentucky to identify factors affecting surgical choice [breast conserving surgery (BCS) vs mastectomy] and appropriate use of adjuvant radiation therapy (RT). Methods: Database collection was done through the Kentucky Cancer Registry. Inclusion criteria included female breast cancer patients diagnosed between 1998 and 2007. Patients were diagnosed with ductal carcinoma in situ or American Joint Committee on Cancer stage I or II disease. Database search was limited to Appalachian residents. Statistical analyses were carried out to identify variables affecting surgical choice, receipt of RT, and survival. Results: Analysis evaluated 5,541 Appalachian patients. The distribution of surgery favored BCS (54.1%) over mastectomy (45.9%). On multivariate analysis, the most significant factors for mastectomy were advanced stage [odds ratio (OR) 2.571, P<0.0001], rural location (OR 2.075, P<0.0001), and insurance status (OR 1.546, P<0.0001). Of patients choosing BCS, 56.2% received adjuvant RT. On multivariate analysis age >70 years (OR 2.506, P<0.0001), rural location (OR 2.416, P<0.0001), and lack of insurance (OR 1.651, P=0.0168) were the strongest predictors for not receiving adjuvant RT. Conclusions: Mastectomy rate remains higher and the rate of RT after BCS is lower in Appalachian women compared with other contemporary studies of women with ductal carcinoma in situ and early stage breast cancer.
KW - Appalachia
KW - breast cancer
KW - disparities
KW - radiation
KW - rural
KW - surgical choice
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U2 - 10.1097/COC.0b013e3182118d27
DO - 10.1097/COC.0b013e3182118d27
M3 - Article
C2 - 21422902
AN - SCOPUS:84864349211
SN - 0277-3732
VL - 35
SP - 358
EP - 363
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 4
ER -