1. Treatment of ductal carcinoma in situ among patients cared for in large integrated health plans.
- Author
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Haque R, Achacoso NS, Fletcher SW, Nekhlyudov L, Collins LC, Schnitt SJ, Quesenberry CP Jr, and Habel LA
- Subjects
- Aged, California, Carcinoma, Ductal ethnology, Cross-Sectional Studies, Female, Humans, Mammary Glands, Human physiopathology, Massachusetts, Medical Audit, Middle Aged, Carcinoma, Ductal radiotherapy, Managed Care Programs, Practice Patterns, Physicians'
- Abstract
Objective: To examine whether use of adjuvant therapy varies by race/ethnicity among patients with ductal carcinoma in situ (DCIS) at 3 integrated health plan delivery sites based in California and Massachusetts., Study Design: Cross-sectional study nested within a cohort of women diagnosed as having DCIS between 1990 and 2001., Methods: We reviewed medical records of 3000 non-Hispanic white (69%), black (10%), Hispanic (9%), and Asian or Pacific Islander (12%) women diagnosed as having DCIS between 1990 and 2001 and treated with breast-conserving therapy. chi(2) Test and multinomial logistic regression analysis were used to examine the association between race/ethnicity and use of adjuvant treatments after controlling for patient and clinical variables, including certain pathologic factors., Results: We found no significant differences in DCIS adjuvant treatment among racial/ethnic groups in bivariate or multinomial analyses after adjusting for demographic characteristics, comorbidity, and clinical factors. Minority women were as likely to undergo adjuvant radiation therapy as non-Hispanic white women. However, women 70 years or older (odds ratio, 0.40; 95% confidence interval, 0.31-0.51) and women who lived in areas with low geocoded median family income (odds ratio, 0.65; 95% confidence interval, 0.48-0.89) were less likely to receive adjuvant radiation therapy. Tumor size and comedo histologic growth pattern were associated with increased likelihood of receiving radiation therapy., Conclusion: Use of adjuvant therapy by minority women in these managed care plans is similar to that by non-Hispanic white women, although use was less among older women and among women who lived in poorer neighborhoods.
- Published
- 2010