Treatment of ductal carcinoma in situ among patients cared for in large integrated health plans

Am J Manag Care. 2010 May;16(5):351-60.


Objective: To examine whether use of adjuvant therapy varies by race/ethnicity among patients with ductal carcinoma in situ (DCIS) at 3 integrated health plan delivery sites based in California and Massachusetts.

Study design: Cross-sectional study nested within a cohort of women diagnosed as having DCIS between 1990 and 2001.

Methods: We reviewed medical records of 3000 non-Hispanic white (69%), black (10%), Hispanic (9%), and Asian or Pacific Islander (12%) women diagnosed as having DCIS between 1990 and 2001 and treated with breast-conserving therapy. chi(2) Test and multinomial logistic regression analysis were used to examine the association between race/ethnicity and use of adjuvant treatments after controlling for patient and clinical variables, including certain pathologic factors.

Results: We found no significant differences in DCIS adjuvant treatment among racial/ethnic groups in bivariate or multinomial analyses after adjusting for demographic characteristics, comorbidity, and clinical factors. Minority women were as likely to undergo adjuvant radiation therapy as non-Hispanic white women. However, women 70 years or older (odds ratio, 0.40; 95% confidence interval, 0.31-0.51) and women who lived in areas with low geocoded median family income (odds ratio, 0.65; 95% confidence interval, 0.48-0.89) were less likely to receive adjuvant radiation therapy. Tumor size and comedo histologic growth pattern were associated with increased likelihood of receiving radiation therapy.

Conclusion: Use of adjuvant therapy by minority women in these managed care plans is similar to that by non-Hispanic white women, although use was less among older women and among women who lived in poorer neighborhoods.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • California
  • Carcinoma, Ductal / ethnology
  • Carcinoma, Ductal / radiotherapy*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Mammary Glands, Human / physiopathology
  • Managed Care Programs*
  • Massachusetts
  • Medical Audit
  • Middle Aged
  • Practice Patterns, Physicians'*