Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer

Jennifer C. Livaudais, Dawn L. Hershman, Laurel Habel, Lawrence Kushi, Scarlett Lin Gomez, Christopher I. Li, Alfred I. Neugut, Louis Fehrenbacher, Beti Thompson, Gloria D. Coronado

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR] = 0.82; [CI] 0.71-0.96 and [OR] = 0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.

Original languageEnglish (US)
Pages (from-to)607-617
Number of pages11
JournalBreast Cancer Research and Treatment
Volume131
Issue number2
DOIs
StatePublished - Jan 2012
Externally publishedYes

Fingerprint

Hormones
Breast Neoplasms
Hispanic Americans
Odds Ratio
Confidence Intervals
Therapeutics
Neoplasms
Aromatase Inhibitors
Tamoxifen
Social Class
African Americans
Population
Prescriptions
Histology
Logistic Models
Radiation
Morbidity
Recurrence
Drug Therapy
Survival

Keywords

  • Adjuvant hormonal therapy
  • Aromatase inhibitors
  • Breast cancer
  • Racial/ethnic disparities
  • Tamoxifen

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. / Livaudais, Jennifer C.; Hershman, Dawn L.; Habel, Laurel; Kushi, Lawrence; Gomez, Scarlett Lin; Li, Christopher I.; Neugut, Alfred I.; Fehrenbacher, Louis; Thompson, Beti; Coronado, Gloria D.

In: Breast Cancer Research and Treatment, Vol. 131, No. 2, 01.2012, p. 607-617.

Research output: Contribution to journalArticle

Livaudais, JC, Hershman, DL, Habel, L, Kushi, L, Gomez, SL, Li, CI, Neugut, AI, Fehrenbacher, L, Thompson, B & Coronado, GD 2012, 'Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer', Breast Cancer Research and Treatment, vol. 131, no. 2, pp. 607-617. https://doi.org/10.1007/s10549-011-1762-1
Livaudais, Jennifer C. ; Hershman, Dawn L. ; Habel, Laurel ; Kushi, Lawrence ; Gomez, Scarlett Lin ; Li, Christopher I. ; Neugut, Alfred I. ; Fehrenbacher, Louis ; Thompson, Beti ; Coronado, Gloria D. / Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer. In: Breast Cancer Research and Treatment. 2012 ; Vol. 131, No. 2. pp. 607-617.
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AB - Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR] = 0.82; [CI] 0.71-0.96 and [OR] = 0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.

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