Differences in Breast Cancer Treatment and Survival among Women with Disabilities

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The summary below is from the full report titled "Disparities in Breast Cancer Treatment and Survival for Women with Disabilities." It is in the 7 November 2006 issue of Annals of Internal Medicine (volume 145, pages 637-645). The authors are E.P. McCarthy, L.H. Ngo, R.G. Roetzheim, T.N. Chirikos, D. Li, R.E. Drews, and L.I. Iezzoni.

What is the problem and what is known about it so far?

Localized breast cancer can be treated with surgery that removes only the cancer (breast-conserving surgery) rather than with surgery that removes the entire breast (mastectomy). Nevertheless, many women with localized breast cancer are not treated with breast-conserving surgery. Socially disadvantaged women, such as those who are older, are poor, or lack health insurance, are generally less likely to receive high-quality health care and are also less likely to undergo breast-conserving surgery. Women with disabilities have both physical and social disadvantages. They may also be less likely to receive high-quality care, including breast-conserving surgery for early-stage breast cancer. However, this has never been studied.

Why did the researchers do this particular study?

To see whether women with localized breast cancer and disabilities are treated differently from and live as long as those without disabilities.

Who was studied?

100,311 women between 21 and 64 years of age who received a diagnosis of localized breast cancer between 1988 and 1999.

How was the study done?

The researchers used 2 large government databases to identify women who were receiving disability benefits when localized breast cancer was diagnosed. They then compared women with disabilities who received mastectomy and breast-conserving surgery with those without disabilities who underwent these surgeries. They also compared the women's survival from the time of diagnosis on the basis of disability and type of treatment.

What did the researchers find?

Women with disabilities were less likely than those without disabilities to be treated with breast-conserving surgery. Women with disabilities also did not survive as long after breast cancer was diagnosed. The shorter survival was not explained by the difference in treatment.

What are the limitations of the study?

The researchers did not have access to information about the full range of breast cancer treatments received by the women or about their disabilities. Therefore, the reasons for the findings are unknown. Also, the findings apply only to women with disabilities who received disability benefits from the federal government.

What are the implications of the study?

Women with disabilities seem less likely to receive breast-conserving surgery than those without disabilities. They also do not seem to survive as long after their breast cancer diagnosis. The reasons for the findings are unknown and should be studied further.