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International Journal of Breast Cancer
Volume 2012, Article ID 453985, 8 pages
http://dx.doi.org/10.1155/2012/453985
Research Article

Racial Differences in the Use of Adjuvant Chemotherapy for Breast Cancer in a Large Urban Integrated Health System

1Department of Oncology, Karmanos Cancer Institute, Wayne State University, 4100 John Road, 4221 HWCRC Detroit, MI 48201, USA
2Population Studies and Disparities Research Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA
3Department of Public Health Sciences, Henry Ford Health Systems, Detroit, MI 48202, USA
4Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48201, USA
5Wayne State University School of Medicine, Detroit, MI 48201, USA

Received 6 January 2012; Revised 18 March 2012; Accepted 19 March 2012

Academic Editor: Wonshik Han

Copyright © 2012 Michael S. Simon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Racial differences in breast cancer survival may be in part due to variation in patterns of care. To better understand factors influencing survival disparities, we evaluated patterns of receipt of adjuvant chemotherapy among 2,234 women with invasive, nonmetastatic breast cancer treated at the Henry Ford Health System (HFHS) from 1996 through 2005. Methods. Sociodemographic and clinical information were obtained from linked datasets from the HFHS, Metropolitan Detroit Cancer Surveillance Systems, and U.S. Census. Comorbidity was measured using the Charlson comorbidity index (CCI), and economic deprivation was categorized using a neighborhood deprivation index. Results. African American (AA) women were more likely than whites to have advanced tumors with more aggressive clinical features, to have more comorbidity and to be socioeconomically deprived. While in the unadjusted model, AAs were more likely to receive chemotherapy (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.02–1.46) and to have a delay in receipt of chemotherapy beyond 60 days (OR 1.68, 95% CI, 1.26–1.48), after multivariable adjustment there were no racial differences in receipt (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.73–1.43), or timing of chemotherapy (OR 1.18, 95 CI, 0.8–1.74). Conclusions. Societal factors and not race appear to have an impact on treatment delay among African American women with early breast cancer.