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Original Article |
1 Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Harvard Medical School, 150 S. Huntington Avenue, (151MAV), Boston, Massachusetts 02130
2 Department of Medicine, University of Hawaii John A. Burns School of Medicine, 1356 Lusitania Street, Honolulu, Hawaii 96813
3 Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rose 139, Boston, Massachusetts 02215
4 Hawaii Medical Service Association (an independent licensee of Blue Cross Blue Shield), 818 Keeaumoku Street, Honolulu, Hawaii 96814
5 Center for Best Healthcare Practice, Queen’s Medical Center, 1301 Punchbowl Street, Honolulu, Hawaii 96813
Correspondence: Address correspondence and reprint requests to: Rebecca P. Gelber, MD, MPH; E-mail: rgelber{at}hsph.harvard.edu.
Background: Little is known about breast cancer management among Asian Americans and Pacific Islanders (AAPI).
Methods: We performed a retrospective analysis of 2030 women (935 Japanese, 144 Chi-nese, 235 Filipino, 293 Hawaiian, and 423 white; mean age ± SD, 59 ± 13 years) with a diagnosis of early breast cancer (stages I, II, and IIIA) in Hawaii from 1995 to 2001. We linked data from the Surveillance, Epidemiology, and End Results program’s Hawaii Tumor Registry to administrative health care claims. We evaluated (1) breast-conserving surgery (BCS); (2) radiotherapy after BCS; and (3) chemotherapy for node-positive disease. We used logistic regression to examine the association between AAPI ethnicity and treatment, adjusting for age, year, rural residence, tumor size, grade, nodal status, receptor status, prior cancer, comorbidity index, health plan type, and income.
Results: Overall, 60.3% of women had stage I disease, 36.8% had stage II, and 2.9% had stage IIIA. Only 55.6% received BCS, and 85.1% of these women also received radiation. Of those with nodal involvement (n = 521), 82.7% received chemotherapy. Japanese and Filipino women were significantly less likely than white women to undergo BCS (for Japanese: adjusted odds ratio, 0.62; 95% confidence interval, 0.48–0.80; for Filipinos: adjusted odds ratio, 0.47; 95% confidence interval, 0.33–0.66). Filipinos tended to be less likely than white women to receive radiation after BCS (adjusted odds ratio, 0.80; 95% confidence interval, 0.42–1.49). AAPI women were as likely as white women to receive adjuvant chemotherapy for nodal spread.
Conclusions: We found disparities in the management of early-stage breast cancer among AAPI women, particularly among Japanese and Filipinos. Further study is needed to determine the reasons for the observed disparities and to understand their effect on health outcomes.
Key Words: Breast cancer • Ethnicity • Disease management • Pacific Islanders • Asian Americans
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