Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment?

PURPOSE Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment. Methods We identif...

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Bibliographic Details
Published in:Breast cancer research and treatment 2024-08, Vol.206 (3), p.509-517
Main Authors: Lubarsky, Maya, Hernandez, Alexandra E, Collie, Brianna L, Westrick, Ashly C, Thompson, Cheyenne, Kesmodel, Susan B, Goel, Neha
Format: Article
Language:English
Subjects:
Adult
Aged
Black or African American - statistics & numerical data
Breast cancer
Breast Neoplasms - ethnology
Breast Neoplasms - therapy
Cancer therapies
Epidemiology
Female
Guideline Adherence - statistics & numerical data
Healthcare Disparities - ethnology
Hispanic or Latino - statistics & numerical data
Humans
Medicine
Medicine & Public Health
Middle Aged
Neighborhoods
Oncology
Practice Guidelines as Topic
Racism
Regression analysis
Residence Characteristics
Segregation
Socioeconomic Factors
Systemic racism
United States
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Summary:PURPOSE Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment. Methods We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment. Results 5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR) Model1 0.58 (0.45–0.74); OR Model2 0.59 (0.46–0.78); OR Model3 0.62 (0.47–0.81); OR Model4 0.53 (0.40–0.69); OR Model5 0.59(0.46–0.76); p  
ISSN:0167-6806
1573-7217
1573-7217
DOI:10.1007/s10549-024-07245-6