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Institutions Treating Breast Cancer Patients of a Low Socioeconomic Status Achieve Multidisciplinary Quality Standards at Lower Rates

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The National Accreditation Program of Breast Centers (NAPBC) certifies institutions that provide quality breast care. Whereas low socioeconomic status (SES) has a negative impact on patient outcomes, it is unknown whether an institution’s patient SES mix is associated with meeting NAPBC standards.

Methods

All institutions submitting at least 100 breast cancer patients to the National Cancer Database (2006–2017) were ranked based on the patients’ insurance status, income, and education. The 10% treating the largest proportion of low-SES patients were termed low-SES institutions (LSES). Patient cohorts were created based on the 2018 NAPBC standards. Uni- and multivariate comparisons of patient, tumor, and treatment factors were made to calculate adjusted odds of meeting each standard between low- and non-low-SES institutions.

Results

The analysis included 1319 institutions. Both the LSES and non-LSES reached the benchmark rate of 50% lumpectomies (61.2 vs 62.9%; p < 0.001), but the unadjusted and adjusted rates of lumpectomy were lower in LSES. The rate for sentinel lymphadenectomy was lower for LSES (49.2 vs 53.7%; p < 0.001). Similarly, the unadjusted and adjusted rates of adjuvant chemotherapy and endocrine therapy were lower at LSES. Although the unadjusted rate of adjuvant radiation was higher at LSES, adjusted odds demonstrated that patients treated at LSES were less likely to undergo adjuvant radiation when appropriate.

Conclusions

Small but significant differences in achieving multidisciplinary standards for quality breast cancer care exist between LSES and non-LSES and may exacerbate disparities already faced by patients of low SES.

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Authors and Affiliations

  1. Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA

    Austin D. Williams MD, MSEd, Robin Ciocca DO, Jennifer L. Sabol MD & Ned Z. Carp MD

Authors
  1. Austin D. Williams MD, MSEd
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  2. Robin Ciocca DO
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  3. Jennifer L. Sabol MD
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  4. Ned Z. Carp MD
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Contributions

Conception and design A.D.W. Collection and assembly of data. A.D.W. Data analysis and interpretation. A.D.W., R.M.C., N.Z.C., Manuscript writing A.D.W., R.M.C., J.L.S., N.Z.C.

Corresponding author

Correspondence to Austin D. Williams MD, MSEd.

Ethics declarations

The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in this study are derived from a de-identified NCDB file. The American College of Surgeons and the American Cancer Society have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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There are no conflicts of interest.

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Williams, A.D., Ciocca, R., Sabol, J.L. et al. Institutions Treating Breast Cancer Patients of a Low Socioeconomic Status Achieve Multidisciplinary Quality Standards at Lower Rates. Ann Surg Oncol 28, 5635–5647 (2021). https://doi.org/10.1245/s10434-021-10451-x

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