Disparities in adherence to breast cancer care

Pragati Advani, The University of Texas School of Public Health


Improvements in screening and treatment methods have resulted in a growing number of breast cancer survivors in the United States. Recognizing factors that influence breast cancer management practices among minority or immigrant women is as crucial as examining how these factors may differ within various racial/ethnic groups of populations. ^ The goal of this dissertation was to examine disparities (by both race/ethnicity and acculturation) in receipt of breast cancer management (both treatment and survivorship care). The specific aim of my first paper was to examine disparities by level of acculturation in the receipt of breast cancer treatment (type of surgery: mastectomy versus breast conserving surgery) and nonadherence to NCCN guidelines for breast cancer survivorship care among female Mexican American breast cancer patients receiving treatment at the MD Anderson Cancer Center and enrolled in the Ella Binational Breast Cancer Study. In the second study, we conducted a systematic review of literature to discuss and critique studies examining racial/ethnic disparities in the use of surveillance mammograms among breast cancer survivors. ^ Although, the association reached borderline level of statistical significance, we found that more acculturated women were less likely to receive a mastectomy (compared to breast conserving surgery) as their primary surgical treatment towards breast cancer. Additionally, these women had lower odds of nonadherence to survivorship care (both surveillance mammograms and clinic visits), although, this association was statistically non-significant. Our systematic review identified 22 unique studies that addressed racial and ethnic disparities in use of surveillance mammogram among breast cancer survivors. Overall, we found statistically significant racial/ethnic disparities in use of surveillance mammogram in thirteen (of 22) studies, with non-White women significantly less likely to receive timely surveillance mammogram compared to Whites for a majority of studies. ^ This research suggests that disparities in receipt of breast cancer care (both treatment and survivorship care) exist, not only by race/ethnicity but also by different levels of acculturation. Future interventions need to focus on providing better guidance to the minority & immigrant patients with their treatment related decisions, as well as improve patient retention in cancer survivorship care.^

Subject Area

Public health|Epidemiology

Recommended Citation

Advani, Pragati, "Disparities in adherence to breast cancer care" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10127451.