Abstract A52: Receipt of adjuvant hormonal therapy among Medicaid enrollees diagnosed with hormone-receptor positive breast cancer, 2004-2007.
Authors: Felder Tisha M. , Lal Lincy S. , Stafkey-Mailey Dana , Do Phoenix , Lu Kevin , Bennett Charles L. 
Published: August 2014

Introduction: In the U.S., Black women are more likely to die from breast cancer compared to Whites, even though Blacks are less likely to be diagnosed with the disease. The disparity in breast cancer mortality is even wider in South Carolina (SC). Several factors may play a role, including racial/ethnic differences in cultural approaches to medical care, access to care, socioeconomics, and differences in response to innovative breast cancer treatments, such as adjuvant hormonal therapy (AHT). AHT significantly reduces breast cancer mortality for women diagnosed with hormone-receptor positive (HR+) breast cancer. The objective of this study is to determine if racial disparities exist in the receipt of AHT among low-income women diagnosed with HR+ breast cancer and who have financial access to care through the state Medicaid program.

Methods: Data for this analysis were derived from the SC Medicaid administrative data linked with SC Central Cancer Registry. Women diagnosed between 2004 and 2007 with stage I-III HR+ breast cancer who underwent initial breast surgery were included in the study. We used multivariable logistic regression to test for racial differences in the receipt of AHT.

Results: Of 578 women included in the study 52% (299) were white (versus Black). On average, study participants were, 57 years old (SD=13yrs) at the time of diagnosis, separated/widowed/divorced (207; 36%), diagnosed at a localized stage (318; 55%) and were from urban counties in the state (392; 68%). Sixty-one percent of women (n=355) received AHT at any point following diagnosis. Among women who received AHT: 56% (n=198) used an aromatase inhibitor only, 35% tamoxifen only (n=124) and 9% (n=33) received both during the study period. Results from the multivariable logistic regression showed that race was not independently associated with AHT receipt. However, the study demonstrated that women less likely to receive AHT were over 65 years old versus under 45 years old [65-74 years: OR= 0.24 (95% CI: 0.088, 0.672); over 75 years: OR=0.20 (95% CI: 0.066, 0.610)] and had grade IV versus grade I tumors [OR=0.05 (95% CI: 0.01, 0.48)], while women who received chemotherapy were more likely to receive AHT [OR=1.9, 95% CI: 1.04, 3.31)]. The likelihood of receipt of AHT decreased over time [OR= 0.60 (95% CI: 0.469, 0.757)].

Conclusions: Findings suggest that in an equal access health care system of Medicaid enrollees in SC, there are no racial differences in the receipt of AHT. This finding is consistent with previous studies examining the use of AHT among other state Medicaid populations. Future studies should investigate additional factors that may contribute to disparities in breast cancer mortality, such as pre-mature discontinuation of AHT or pharmacogenomics differences in responsiveness to AHT.

Citation Format: Tisha M. Felder, Lincy S. Lal, Dana Stafkey-Mailey, Phoenix Do, Kevin Lu, Charles L. Bennett. Receipt of adjuvant hormonal therapy among Medicaid enrollees diagnosed with hormone-receptor positive breast cancer, 2004-2007. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A52.