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Regional Disparities in Breast Cancer Outcomes and the Process of Care

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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.
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Document Type: Research Article

Affiliations: Division of Surgical Oncology, East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA

Publication date: July 1, 2014

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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