Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA; Depatment of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA.
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA.
Clin Breast Cancer. 2023 Jul;23(5):561-566. doi: 10.1016/j.clbc.2023.04.008. Epub 2023 Apr 25.
Despite evidence suggesting oncologic equipoise of breast conservation therapy (BCT) for early-stage (stages I and II) breast cancer, mastectomy is still widely utilized.
The 2004-2015 National Cancer Database was used to tabulate all adult women receiving mastectomy or BCT for early-stage breast cancer. Multivariable regression was used to evaluate factors associated with utilization of BCT, relative to mastectomy.
Of 1,079,057 women meeting study criteria, 57.4% underwent BCT. BCT patients were older and more commonly White, compared to mastectomy. They were more commonly privately insured, in the highest income quartile, and treated at metropolitan, nonacademic institutions. After adjustment, increasing age (AOR 1.01/year), Black race (AOR 1.21, Ref: White), and care at a community hospital (AOR 1.08, Ref: Academic; all P< .05) were associated with increased odds of undergoing BCT. Conversely, Asian or Pacific Islander (AAPI) race (AOR 0.74), Medicare (AOR 0.89) or Medicaid (AOR 0.95) coverage, and being in the lowest (AOR 0.95) and second lowest (AOR 0.98, all P< .05) income quartiles were associated with reduced odds of undergoing BCT. Finally, increasing tumor size (AOR 0.97, P< .05) was associated with decreased adjusted odds of undergoing BCT.
Our results suggest persistent socioeconomic and racial disparities in BCT utilization for early-stage breast cancer. Directed strategies should be implemented in order to reduce treatment inequality in this patient population.
尽管有证据表明保乳治疗（BCT）在早期（I 期和 II 期）乳腺癌中的肿瘤学平衡，但乳房切除术仍被广泛应用。
本研究使用了 2004 年至 2015 年国家癌症数据库，对所有接受早期乳腺癌乳房切除术或 BCT 的成年女性进行了制表。采用多变量回归分析评估了与接受乳房切除术相比，接受 BCT 的相关因素。
在符合研究标准的 1079057 名女性中，有 57.4%接受了 BCT。与接受乳房切除术的患者相比，BCT 患者年龄更大，更常见为白人。他们更常见于私人保险，收入处于最高四分位数，在大都市、非学术机构接受治疗。调整后，年龄增加（AOR 1.01/年）、黑人种族（AOR 1.21，参考：白人）和在社区医院接受治疗（AOR 1.08，参考：学术；所有 P<0.05）与接受 BCT 的可能性增加相关。相反，亚裔或太平洋岛民（AAPI）种族（AOR 0.74）、医疗保险（AOR 0.89）或医疗补助（AOR 0.95）覆盖范围以及收入处于最低（AOR 0.95）和第二低（AOR 0.98，所有 P<0.05）四分位数与接受 BCT 的可能性降低相关。最后，肿瘤大小增加（AOR 0.97，P<0.05）与接受 BCT 的调整后可能性降低相关。
我们的研究结果表明，在早期乳腺癌的 BCT 应用中存在持续的社会经济和种族差异。应实施有针对性的策略，以减少这一患者群体的治疗不平等。
