ABSTRACT
Purpose:
Disparities have been reported in
women treated for
breast cancer (BrCa). This study examines potential disparities in BrCa
treatment offered based on
race and age from a multicenter
radiation department.
Methods and Materials We identified 901
patients with early stage BrCa
who received curative
intent radiation therapy (RT) between 2004 and 2018. Data extracted included age,
race,
disease stage,
treatment technique,
treatment dates, and fractionation.
Patient race was recorded as
Asian, Black,
Hispanic, and
White. RT
technique delivered was classified as a type of external beam
radiation therapy or
brachytherapy/intraoperative
radiation therapy. Fractionation schema were defined as 1) standard fractionation, 1.8-2 Gy; 2) hypofractionation, 2.5-2.67 Gy; 3) accelerated partial
breast irradiation (APBI), 3.4 Gy - 4.25 Gy, and 4) intraoperative
radiation therapy,
single dose of 20 Gy. Stage was recorded using
TNM staging. The χ2 test and a multivariable multinomial
logistic regression model were used to assess whether
patient characteristics, such as age,
race, or stage influenced fractionation schemes. Results with 2-sided P values < .05 were considered statistically significant.
Results:
Racial composition of the study was 13.8%
Asian, 22% Black, 29%,
White, and 35.1%
Hispanic. Mean age was 61 and was divided into 4 age range groups 30 to 49 (n = 160), 50 to 59 (n = 231), 60 to 69 (n = 294), and ≥70 years (n = 216). In addition, 501
patients (56%) received hypofractionation, 342 (38.8%) received standard fractionation, and 58 (7.1%) received APBI, respectively. For all groups, hypofractionation became more common over
time. Age ≥70 years was associated with 9 times higher odds of APBI and 14 times higher odds of hypofractionation, compared with age 30 to 49 years. After adjusting for the other predictors in a multivariable multinomial
logistic regression model, the
race distribution differed among the 3 groups (P = .03), with a smaller percentage of
Hispanics and higher percentage of
blacks in the standard group.
Conclusions:
This study of a diverse cohort of
patients with
breast cancer failed to identify
treatment differences associated by
race. The study found an
association between age and hypofractionation.
