Health Disparities
Guideline-Concordance Along the Cancer Care Continuum and Breast Cancer Mortality by Race and Ethnicity: a SEER-Medicare Study Emma L Herbach* Emma Herbach Herbach Herbach Herbach Herbach Herbach Herbach Herbach Herbach University of Miami Sylvester Comprehensive Cancer Center
Purpose. To examine the relationship between guideline-concordant breast cancer care and hazard of cancer death by patient race and ethnicity.
Methods. We used SEER-Medicare data to identify 212,555 older women diagnosed with invasive breast cancer between 2000-2017. Guideline-concordant diagnostic workup, locoregional treatment, and initiation of systemic therapy were defined using NCCN guidelines. Hazards of breast cancer death 2- and 5-years from diagnosis by each guideline-concordance outcome overall and stratified by race and ethnicity were estimated using Cox proportional hazards models.
Results. Non-concordant diagnostic workup, locoregional treatment, and systemic therapy initiation were each associated with increased hazards of 2- and 5-year breast cancer mortality (diagnostics HR2-year (95% CI) 1.33 (1.25-1.41), HR5-year 1.29 (1.23-1.35); locoregional HR2-year 2.10 (1.98-2.23), HR5-year 1.83 (1.76-1.90); systemics HR2-year 1.67 (1.51-1.84), HR5-year 1.56 (1.45-1.68)). Non-concordant diagnostic workup and systemic therapy initiation were associated with greater hazard of 2- and 5-year breast cancer death among Black, Asian/Pacific Islander, Hispanic White, and non-Hispanic White patients; there was no consistent association among American Indian/Alaska Native patients for either outcome. Locoregional treatment was strongly associated with hazards of cancer death for all groups.
Conclusions. Equitable delivery of guideline-recommended breast cancer care from diagnosis through treatment across racial and ethnic groups may mitigate survival disparities. Efforts to improve access to high-quality care must be informed by and responsive to the social and structural root causes of health inequities.