Selection of treatment among Latina and non-Latina white women with ductal carcinoma in situ

Abstract

Background: The growing rates of ductal carcinoma in situ (DCIS) and evidence that Latinas may underuse breast-conserving surgery (BCS) compared with white women highlight the need to better understand how treatment decisions are made in this understudied group. To help address this gap, this study compared surgery and radiation treatment decision making among white and Spanish-speaking and English-speaking Latina women with DCIS recruited from eight population-based cancer registries from 35 California counties.

Methods: Women aged ≥18 who self-identified as Latina or non-Latina white diagnosed with DCIS between 2002 and 2005 were selected from eight California Cancer Registry (CCR) regions and surveyed about their DCIS treatment decision making by telephone approximately 24 months after diagnosis. Survey data were merged with CCR hospital-based records to obtain tumor and treatment data.

Results: Mean age was 57 years. Multivariate analysis indicated no differences by ethnicity or language in the receipt of mastectomy vs. BCS after controlling demographic, health, and personal preferences. English-speaking Latinas were more likely to receive radiation than their Spanish-speaking or white counterparts, controlling for demographic and other factors. Among women receiving BCS, physician recommendation was the strongest predictor of receipt of radiation.

Conclusions: Ethnic disparities in surgical treatment choices after breast cancer diagnosis were not seen in this cohort of women diagnosed with DCIS. Physicians play an essential role in patients' treatment choices for DCIS, particularly for adjuvant radiation.

Figures

FIG. 1.

Factors influencing surgery, by ethnicity language. Average values reported by each ethnicity language group are shown for the patient factors that influenced their decision on the type of surgery to undergo. The scale was from 1(no influence at all) to 3 (a lot of influence). , Spanish-speaking Latinas; , English-speaking Latinas; , white women.

FIG. 2.

Factors influencing radiation among breast-conserving surgery patients who did not receive radiation, by ethnicity language. Percentage of patients who cited each influence factor for the three ethnicity language groups for patients who did not receive radiation. , Spanish-speaking Latinas; , English-speaking Latinas; , white women.