Racial, ethnic differences seen in breast cancer treatment declination

For patients with breast cancer, there are racial and ethnic differences in treatment declination, according to a study published online May 9 in JAMA Network Open.

Jincong Q. Freeman, M.P.H., from the University of Chicago, and colleagues examined trends and racial and ethnic disparities in treatment declination and overall survival using data from patients with breast cancer from 2004 to 2020. Four treatment modalities were assessed: chemotherapy, hormone therapy (HT), radiotherapy, and surgery.

Data were included from 2,837,446 patients. The researchers found that 9.6, 6.1, 5.0, and 0.6 percent of the 1,296,488, 1,635,916, 1,893,339, and 2,590,963 patients declined chemotherapy, radiotherapy, HT, and surgery, respectively. The likelihood of declining surgery was increased for American Indian, Alaska Native, or other patients, Asian or Pacific Islander patients, and Black patients compared with white patients (adjusted odds ratios, 1.47, 1.29, and 2.01, respectively.

American Indian, Alaska Native, or other patients and Asian or Pacific Islander patients were more likely to decline chemotherapy (adjusted odds ratios, 1.13 and 1.21, respectively); and Black patients were more likely to decline radiotherapy (adjusted odds ratio, 1.05). The likelihood of declining HT was lower for Asian and Pacific Islander patients, Black patients, and Hispanic patients (adjusted odds ratios, 0.81, 0.86, and 0.66, respectively).

Higher mortality was seen for Black versus white patients who declined chemotherapy (adjusted hazard ratio, 1.07), while no overall survival differences were seen for Black and white patients who declined HT or radiotherapy.

"Our findings highlight racial and ethnic disparities in declination of treatment recommendations and overall survival, suggesting the need for equity-focused interventions," the authors write.

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