Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor–positive breast cancer
Open accessAbstract
Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as two or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional-stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC). Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White [NHW]) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use. Our sample included 13,753 women aged 20-79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR] = 0.82; [CI] 0.71-0.96 and [OR] = 0.78; [CI] 0.63-0.98, respectively). Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other insured populations and the reasons for under-initiation among these groups need to be explored.
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Frailty tends to be a concern in older women, while fertility issues uniquely impact younger premenopausal survivors.
“Frailty tends to be a concern in older women37 while fertility issues uniquely impact younger premenopausal survivors.38”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [38]
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- Authors
- Livaudais, J. C., Hershman, D. L., Habel, L., Kushi, L., Gomez, S. L., Li, C. I., Neugut, A. I., Fehrenbacher, L., Thompson, B., & Coronado, G. D.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Columbia University Irving Medical Center (US)
- Kaiser Permanente (US)
- Cancer Prevention Institute of California (US)
- University of Washington (US)
- Corresponding author
- Livaudais, Jennifer C.
- ORCID
- Venue
- Breast Cancer Research and Treatment
- Published
- 2011-09-16
- Volume
- 131
- Issue
- 2
- Pages
- 607-617
- ISSN
- 0167-6806 (ISSN-L)
- 1573-7217
- PMC
- PMC3375495
- OpenAlex
- W2055535124
- Cited by
- 93
- References
- 43
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 11 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 8 · 2017: 11 · 2016: 5 · 2015: 6 · 2014: 11 · 2013: 8 · 2012: 9
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Breast Cancer Research and Treatment (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Cancer Society
- National Institutes of Health (n01pc35136-24-0-2)
- National Cancer Institute (N01PC35136, R01CA098838, R25CA092408, R01CA105274, N01 PC035136, R01 CA98838)
- National Center for Research Resources (TL1RR025016)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- adjuvant endocrine therapy, hormone receptor-positive breast cancer, racial and ethnic disparities, tamoxifen, aromatase inhibitors, Hispanic women, Chinese women, treatment initiation, Kaiser Permanente Northern California, insured population, socioeconomic status
- MeSH terms
- Aged, Breast Neoplasms, California, Ethnicity, Female, Humans, Middle Aged, Chemotherapy, Adjuvant, Antineoplastic Agents, Hormonal
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