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社区社会经济地位与低价值乳腺癌护理。

Neighborhood socioeconomic status and low-value breast cancer care.

机构信息

Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA.

Department of Biomedical Informatics, University of Pittsburg, Pittsburg, Pennsylvania, USA.

出版信息

J Surg Oncol. 2022 Sep;126(3):433-442. doi: 10.1002/jso.26901. Epub 2022 Apr 22.


DOI:10.1002/jso.26901
PMID:35452136
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9541043/
Abstract

BACKGROUND: The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and receipt of low-value breast cancer procedures. METHODS: Patients with breast cancer diagnosed between 2010 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER) Program. Low value procedures included: (1) axillary lymph node dissection (ALND) for patients with limited nodal disease receiving breast conservation therapy (BCT); (2) contralateral prophylactic mastectomies (CPM); and (3) sentinel lymph node biopsies (SLNB) in patients ≥70 years old with clinically node negative early-stage hormone-positive breast cancer. The cohort was divided by nSES. Univariable and multivariable logistic regression analysis compared the groups. RESULTS: The study included 412 959 patients. Compared to patients in high nSES areas, residing in neighborhoods with low nSES (odd ratio [OR] 2.20, 95% confidence interval [CI] 2.0-2.42) and middle nSES (OR 1.42, 95% CI 1.20-1.56) was associated with a higher probability of undergoing low value ALND. Conversely, patients in low SES neighborhoods were less likely to receive low value SLNB (OR 0.89, 95% CI 0.85-0.94) or CPM than (low nSES OR 0.75, 95% CI 0.73-0.77); middle nSES OR 0.91 (0.89-0.92) those in high SES neighborhoods. CONCLUSION: In the SEER Program, low nSES was associated with a lower probability of low value procedures except for ALND utilization.

摘要

背景:本研究旨在探讨社区社会经济地位(nSES)与接受低价值乳腺癌治疗之间的关联。

方法:在监测、流行病学和最终结果(SEER)计划中,确定了 2010 年至 2016 年间被诊断患有乳腺癌的患者。低价值治疗包括:(1)接受保乳治疗(BCT)的局部淋巴结疾病有限的患者的腋窝淋巴结清扫术(ALND);(2)对临床阴性早期激素阳性乳腺癌且年龄≥70 岁的患者进行预防性对侧乳房切除术(CPM);(3)前哨淋巴结活检术(SLNB)。根据 nSES 将队列分为不同组。使用单变量和多变量逻辑回归分析比较组间差异。

结果:本研究纳入了 412959 名患者。与高 nSES 地区的患者相比,居住在低 nSES(比值比 [OR] 2.20,95%置信区间 [CI] 2.0-2.42)和中 nSES(OR 1.42,95% CI 1.20-1.56)社区的患者接受低价值 ALND 的可能性更高。相反,低 SES 社区的患者接受低价值 SLNB(OR 0.89,95% CI 0.85-0.94)或 CPM 的可能性较低(低 nSES OR 0.75,95% CI 0.73-0.77);中 nSES OR 0.91(0.89-0.92)低于高 SES 社区的患者。

结论:在 SEER 计划中,低 nSES 与低价值治疗的可能性降低有关,但 ALND 的使用除外。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8aee/9541043/6405fd7867bd/JSO-126-433-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8aee/9541043/6405fd7867bd/JSO-126-433-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8aee/9541043/6405fd7867bd/JSO-126-433-g001.jpg

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引用本文的文献

[1]
Primary Care Physician Characteristics and Low-Value Care Provision in Japan.

JAMA Health Forum. 2025-6-7

[2]
Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness.

Cancer Epidemiol Biomarkers Prev. 2025-7-1

[3]
Comparison of Low-Value Care Among Commercial and Medicaid Enrollees.

J Gen Intern Med. 2023-3

本文引用的文献

[1]
Intersectionality in cancer care: A systematic review of current research and future directions.

Psychooncology. 2022-5

[2]
Low neighborhood socioeconomic status is associated with higher mortality and increased surgery utilization among metastatic breast cancer patients.

Breast. 2021-10

[3]
Surgical Decision-Making Surrounding Contralateral Prophylactic Mastectomy: Comparison of Treatment Goals, Preferences, and Psychosocial Outcomes from a Multicenter Survey of Breast Cancer Patients.

Ann Surg Oncol. 2021-12

[4]
Intersectionality and the Surgical Patient: Expanding the Surgical Disparities Framework.

Ann Surg. 2022-1-1

[5]
"I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema.

Womens Health (Lond). 2021

[6]
Racial disparities in low-value surgical care and time to surgery in high-volume hospitals.

J Surg Oncol. 2021-2

[7]
Changes in utilization of axillary dissection in women with invasive breast cancer and sentinel node metastasis after the ACOSOG Z0011 trial.

Breast J. 2021-3

[8]
Trends in Contralateral Prophylactic Mastectomy Utilization for Small Unilateral Breast Cancer.

J Surg Res. 2021-6

[9]
Uptake of Breast Cancer Clinical Trials at Minority Serving Cancer Centers.

Ann Surg Oncol. 2021-9

[10]
Neighborhood Social Environmental Factors and Breast Cancer Subtypes among Black Women.

Cancer Epidemiol Biomarkers Prev. 2021-2

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