Regional disparities in breast cancer outcomes and the process of care

Abstract

Mortality from breast cancer in eastern North Carolina (ENC) surpasses the rest of North Carolina (RNC). We sought to identify modifiable factors associated with the increased mortality of women diagnosed with breast cancer in ENC. A retrospective cohort study of women diagnosed with breast cancer in North Carolina between January 1, 2004, and December 31, 2007 (n = 27,631) was studied. There was no difference in the pathologic T (P = 0.62), N (P = 0.26), or stage grouping (P = 0.25) at diagnosis. Women in ENC were less likely to be white (P < 0.001), estrogen receptor (ER)-positive (P < 0.001), progesterone receptor (PR)-positive (P < 0.001), or to receive adjuvant chemotherapy (P = 0.02). The median survival of ENC patients was worse than RNC patients (39 vs. 43 months, P = 0.003). Improved median survival was associated with ER status (P < 0.001), PR status (P < 0.001), race/ethnicity (P < 0.001), and delivery of timely chemotherapy (P < 0.0001). ER-negative status (P = 0.01), black race (P = 0.03), and adjuvant chemotherapy within 90 days of surgery (P < 0.001) remained significant predictors of survival. The poor outcomes observed in ENC can be attributed to recognized prognostic primary patient and tumor characteristics. However, a failure in process of care remains significantly associated with poorer outcomes. Improved timing of delivery of chemotherapy could affect breast cancer mortality.