Disparities in Risk Reduction Therapy Recommendations for Young Women With Lobular Carcinoma In-Situ.

Publication Title

Clinical breast cancer

Authors

Bradley Bandera, John Wayne Cancer InstituteFollow
Amy Voci, John Wayne Cancer InstituteFollow
Daniel Nelson, John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USAFollow
Stacey L Stern, John Wayne Cancer Institute at Providence Saint John's Hospital, Santa Monica, CAFollow
Dany Barrak, Department of Surgery, John Wayne Cancer Institute, Santa Monica, CA
Trevan D Fischer, Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Maggie L DiNome
Melanie Goldfarb, John Wayne Cancer InstituteFollow

Document Type

Article

Publication Date

1-28-2020

Keywords

diversity/inclusion

Abstract

BACKGROUND: Endocrine therapy (ET) significantly reduces the risk of breast cancer development in high-risk patients diagnosed with lobular carcinoma in situ (LCIS). However, the variables impacting recommendation and use of ET in young adults (YAs) is not well-studied. We examined the role of provider recommendation and patient acceptance for ET for YAs with LCIS.

MATERIALS AND METHODS: The National Cancer Database was queried for women aged < 40 years with primary LCIS between 2000 and 2012. Socioeconomic, demographic, and treatment variables were examined to determine their impact on ET provider recommendation and initial patient acceptance of risk-reducing therapy.

RESULTS: Among 1650 YA patients with LCIS, only 749 (45.4%) were recommended ET. On multivariable analysis, women > 30 years of age were more likely recommended ET than women < 30 years (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.10-2.47), African Americans more than other ethnicities (OR, 1.48; 95% CI, 1.1-2.0), and YAs treated in New England were more likely than those in the rest of the country (OR, 3.26; 95% CI, 2.0-5.2). Among YA women recommended ET, only 20.2% had a documented refusal. Only geography appeared to independently impact the likelihood of refusal, with YAs in the Southeastern-Central United States being most likely to refuse ET (OR, 5.4; 95% CI, 1.2-24.0).

CONCLUSION: ET is underutilized for risk-reduction in YAs with LCIS. This underuse appears dependent on disparities in provider recommendation practices rather than non-acceptance of therapy. This may reflect regional practice patterns, community standards of care, or provider bias regarding the significance of LCIS as a risk factor for development of invasive cancer.

Clinical Institute

Cancer

Clinical Institute

Women & Children

Specialty/Research Institute

Oncology