Patient, Hospital, and Neighborhood Factors Associated with Treatment of Early-Stage Breast Cancer among Asian American Women in California
Patient, Hospital, and Neighborhood Factors Associated with Treatment of Early-Stage Breast Cancer among Asian American Women in California
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DOI：
10.1158/1055-9965.epi-11-1143
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发表时间：
2012-05-01
影响因子：
3.8
通讯作者：
Kurian, Allison W.
中科院分区：
文献类型：
--
作者：
Gomez, Scarlett Lin;Press, David J.;Kurian, Allison W.
背景：临床指南推荐保乳手术(BCS)加放射治疗早期乳腺癌是乳房切除术的一种可行的替代方案。然而，亚裔美国人比其他群体更有可能在BCS后接受乳房切除术或忽略放射治疗。方法：我们应用多肿瘤Logistic回归和递归分割方法分析了1990-2007年间被诊断为IT乳腺癌0期的20987名加州亚裔美国人中与乳房切除术或无放射BCS相关的因素。结果：接受乳房切除术的比例在美国出生的中国人中为40%，在外国出生的越南人中为58%。与乳房切除相关的因素包括肿瘤大小等肿瘤特征，某些亚裔美国人的年龄较大和外国出生地等患者特征，以及其他因素，包括医院[较小的医院规模，不是国家癌症研究所癌症中心，较低的社会经济地位(SES)患者构成，以及高医院亚裔美国人的患者构成]和邻里特征(SES较低的种族飞地)。这些医院和社区特征也与无辐射的BCS有关。通过递归分区，根据肿瘤的大小和解剖位置等特征，结合诊断年份和原住地，确定最高的乳房切除亚组。结论：肿瘤特征以及其次是患者、医院和邻近因素是亚裔美国人BCS术后乳房切除和不进行放射治疗的预测因素。影响：通过关注患者、医院和邻近因素在乳腺癌治疗差异性接受中的相互作用，我们的研究确定了感兴趣的亚组，以便进一步研究并转化为公共卫生和以患者为中心的倡议，以确保所有女性都充分了解治疗方案。癌症流行病学生物标志物猎物；21(5)；821-34。(C)2012年AACR。
Background: Clinical guidelines recommend breast-conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans are more likely than other groups to have mastectomy or omit radiation after BCS.Methods: We applied polytomous logistic regression and recursive partitioning to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California Asian Americans diagnosed with stage 0 to IT breast cancer from 1990 to 2007.Results: The percentage receiving mastectomy ranged from 40% among U.S.-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some Asian Americans ethnicities, and additional factors including hospital [smaller hospital size, not National Cancer Institute cancer center, low socioeconomic status (SES) patient composition, and high hospital Asian Americans patient composition] and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through recursive partitioning, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity.Conclusions: Tumor characteristics and, secondarily, patient, hospital, and neighborhood factors are predictors of mastectomy and omission of radiation following BCS among Asian Americans.Impact: By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options. Cancer Epidemiol Biomarkers Prey; 21(5); 821-34. (C)2012 AACR.