Abstract 4216: Racial disparities in receipt of adjuvant hormonal therapy among patients diagnosed with breast cancer in South Carolina
Authors: Babatunde Oluwole A. , Adams Swann , Felder Tisha , Eberth Jan , Moran Robert , Sercy Erica , Hebert James 
Published: July 2017

Background: Women with hormone receptor-positive (HR+) breast cancers (BC) have experienced significant reductions in mortality as a result of the use of adjuvant hormonal therapy (AHT). However, mortality rates remain higher among Blacks compared to Whites. This disparity has widened despite overall improved BC survival rates over time. The widening gap in Black-White mortality for BC may be related to differences in tumor biology, treatments received and access to care. The objective of this study was to assess racial disparities in the receipt of AHT among patients diagnosed with BC in South Carolina (SC).

Methods: We derived data on all female BC cases in 2002 to 2009 from the Central Cancer Registry linked with administrative medical and pharmacy claims data for the Public Employee Benefits Plan (private insurance) and Medicaid. HR+ BC included three potential classifications for estrogen (ER+ or ER-) and progesterone receptors (PR+ or PR-): ER+/PR+, ER+/PR-, ER-/PR+. The main outcome variable was receipt of AHT (receipt vs non-receipt). The main exposure variable was patient race (White vs Black). Chi-square tests and logistic regression analyses were conducted to compare patients who received AHT to those who did not to identify important predictors of AHT receipt. Two-way interactions were assessed between seven covariates hypothesized to modify the effect of race (age at diagnosis, marital status, county of residence, year of diagnosis, receipt of surgery (early vs late), tumor stage and tumor grade).

Results: Of the 1611 total breast cancer cases reported in the study period, 834 were HR+ (641 white, 76.86%; 193 black, 23.14%). The crude odds of non-receipt of AHT were 1.59 (95% CI: 1.14-2.21), and the adjusted odds was 1.23 (95% CI: 0.85-1.78) among Black compared to White patients. The adjusted odds of non-receipt of AHT were 2.02 (95% CI: 1.36-2.99) and 5.15 (95% CI: 3.41-7.77) among tumor grade II and III/IV compared to grade I respectively. Stratified analysis showed that among patients who were married, the odds of non-receipt of AHT were 2.19 (95% CI: 1.28-3.74) among Blacks compared to Whites; among those that received late surgery, the odds of non-receipt of AHT were 3.00 (95% CI: 1.34-6.71) among Blacks compared to Whites; and among tumor stages II and III/IV, the odds of non-receipt of AHT were 1.81 and 2.42 (95% CI: 1.14-2.87 and 1.29-4.55), respectively among Blacks compared to Whites.

Conclusions: To improve overall use of AHT, efforts need to be directed at Black BC patients that received late surgery (&gt;30 days after diagnosis).

Citation Format: Oluwole A. Babatunde, Swann Adams, Tisha Felder, Jan Eberth, Robert Moran, Erica Sercy, James Hebert. Racial disparities in receipt of adjuvant hormonal therapy among patients diagnosed with breast cancer in South Carolina [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4216. doi:10.1158/1538-7445.AM2017-4216