Cancer Prevention Institute of California, Fremont, CA 94538, USA.
Cancer Epidemiol Biomarkers Prev. 2012 May;21(5):821-34. doi: 10.1158/1055-9965.EPI-11-1143. Epub 2012 Mar 8.
Clinical guidelines recommend breast-conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans are more likely than other groups to have mastectomy or omit radiation after BCS.
We applied polytomous logistic regression and recursive partitioning to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California Asian Americans diagnosed with stage 0 to II breast cancer from 1990 to 2007.
The percentage receiving mastectomy ranged from 40% among U.S.-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some Asian Americans ethnicities, and additional factors including hospital [smaller hospital size, not National Cancer Institute cancer center, low socioeconomic status (SES) patient composition, and high hospital Asian Americans patient composition] and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through recursive partitioning, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity.
Tumor characteristics and, secondarily, patient, hospital, and neighborhood factors are predictors of mastectomy and omission of radiation following BCS among Asian Americans.
By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options.
临床指南推荐保乳手术（BCS）联合放疗作为早期乳腺癌治疗的一种可行替代方案，可与乳房切除术相媲美。然而，亚洲裔美国人比其他人群更倾向于接受乳房切除术或在接受 BCS 后不进行放疗。
我们应用多项逻辑回归和递归分区分析，对 1990 年至 2007 年间加利福尼亚州 20987 名诊断为 0 期至 2 期乳腺癌的亚裔美国人进行分析，以确定与接受乳房切除术或 BCS 后不进行放疗相关的因素。
接受乳房切除术的比例从美国出生的中国人的 40%到外国出生的越南人的 58%不等。与乳房切除术相关的因素包括肿瘤特征（如肿瘤较大）、患者特征（如某些亚洲裔美国人年龄较大和为外国出生）以及其他因素（如医院特征[医院规模较小、非美国国立癌症研究所癌症中心、低社会经济地位（SES）患者构成和高医院亚洲裔美国人患者构成]和社区特征[低 SES 少数民族聚居区]）。这些医院和社区特征也与 BCS 后不进行放疗相关。通过递归分区，根据肿瘤特征（如大小和解剖位置）以及诊断年份和原籍国，确定了最高的乳房切除术亚组。
肿瘤特征，其次是患者、医院和社区因素，是亚洲裔美国人接受乳房切除术和 BCS 后不进行放疗的预测因素。
通过关注患者、医院和社区因素之间的相互作用，我们的研究确定了感兴趣的亚组，以便进一步研究，并将其转化为公共卫生和以患者为中心的举措，以确保所有女性都充分了解治疗选择。
