The Influence of Black Race and Socioeconomic Status on the Use of Breast-conserving Surgery for Medicare Beneficiaries

Background: This study explores the influence of socioeconomic status (SES) and black race on the use of breast-conserving surgery (BCS) as opposed to mastectomy for early stage breast carcinoma.

Methods: A cohort of 41,937 female Medicare inpatients age 65-79 years who had undergone BCS or mastectomy treatment in 1990 for local or regional breast carcinoma was studied. SES was estimated based on the patients' zip code of residence.

Results: Greater use of BCS was associated with higher income and increased education as determined by the patients' zip code area (P < 0.001 for each), and with lower vacant housing rates and fewer persons living below the poverty line in the patients' zip code area (P < 0.001 for each). Black women were less likely than women of other races to undergo BCS (odds ratio, 0.80; 95% confidence interval, 0.71-0.91). However, in a multivariate regression model adjusting for stage and urban versus rural residence, income, educational status, and poverty rate remained significant predictors of patient receipt of BCS, whereas black race did not remain an independent predictor of this treatment.

Conclusions: Women residing in higher SES areas are more likely to undergo BCS. The reduced use of BCS in black women appears attributable to SES.