Patterns of Care and Disparities in the Treatment of Early Breast Cancer

Prior research evidence that has suggested that regional variation and socioeconomic barriers in breast cancer treatment remain substantial problems for patients across the nation. The purpose of our project was to characterize national patterns in the treatment of early invasive breast cancer in older women with incident disease. We specifically sought to characterize variation in cost of cancer care across the nation. Methods. We sought to apply a novel resource, comprehensive national Medicare claims data, to study cost variations in women treated for breast cancer. We first identified patients with invasive breast cancer treated with mastectomy or breast conserving surgery (BCS) and evaluated variations in breast cancer treatment utilization and resulting costs of treatment. Multivariate logistic and liniear regression was used to model these outcomes. Findings. Significant regional variation in utilization of breast cancer treatment existed in our cohort of older women diagnosed with invasive disease, even after standardization for patient and disease characteristics. In addition, significant disparities in costs or spending for breast cancer existed, with not only patient and clinical factors playing a significant role in costs, but also socioeconomic factors. Conclusions. Our research adds to the existing literature by providing the first comprehensive national sample to address these study questions. Our future research will extend on our current findings by determining whether these variations in breast cancer treatment also affect outcomes, such as cancer recurrence, mortality and costs of cancer care.