Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA.
J Surg Oncol. 2023 Mar;127(4):541-549. doi: 10.1002/jso.27173. Epub 2022 Dec 12.
Understanding racial disparity is crucial to addressing health equity and access to care. Our study aims to examine racial differences in breast conserving surgery (BCS) utilization rates and determine how these rates have changed over time.
This retrospective cohort analysis utilized the NSQIP database to identify women diagnosed with breast cancer who underwent BCS procedures between 2008 and 2019. Racial utilization trends were analyzed using a Cochran-Armitage test and Index of Disparity analysis.
In the 12-year period, 202 492 women underwent a breast cancer surgery, of which 47% underwent BCS. Within the BCS subgroup, oncoplastic surgery utilization increased from 3% to 10%, leading to a declining proportion of partial mastectomies: 97% to 90.0% (both p < 0.01). The racial index of disparity for overall BCS patients decreased from 7% to 6%, remained unchanged (1%) for partial mastectomies, and significantly decreased in oncoplastics (23%-7.6%).
BCS represents a mainstay option for early-staged breast cancer interventions, this study demonstrate promising progress in decreasing the index of disparity among races and persistent racial inequalities.
了解种族差异对于解决健康公平和获得医疗服务至关重要。我们的研究旨在探讨在接受保乳手术(BCS)方面的种族差异,并确定这些差异随时间的变化情况。
本回顾性队列分析利用 NSQIP 数据库,确定了 2008 年至 2019 年间接受 BCS 手术的乳腺癌女性患者。使用 Cochran-Armitage 检验和差异指数分析来分析种族利用趋势。
在 12 年期间,有 202492 名女性接受了乳腺癌手术,其中 47%接受了 BCS。在 BCS 亚组中,肿瘤整形手术的利用率从 3%增加到 10%,导致部分乳房切除术的比例下降:从 97%降至 90.0%(均 p<0.01)。整体 BCS 患者的种族差异指数从 7%降至 6%,部分乳房切除术不变(1%),肿瘤整形术显著下降(23%-7.6%)。
BCS 是早期乳腺癌干预的主要选择,本研究表明在减少种族间差异指数方面取得了有希望的进展,但仍存在持续的种族不平等。