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Surgery Refusal Among Black and Hispanic Women with Non-Metastatic Breast Cancer

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

Abstract

Background

Studies have shown a lower receipt of treatment among minority women with non-metastatic breast cancer. Those who refuse surgery have increased disease-specific mortality, contributing to disproportionately higher breast cancer mortality in non-Hispanic black (NHB) and Hispanic women. This study aimed to assess surgery refusal in these groups, identify factors associated with surgery refusal, and characterize the association between surgery refusal and survival.

Methods

Surveillance, Epidemiology, and End Results (SEER) Program data from 2005 to 2015 for NHB and Hispanic women with a diagnosis of non-metastatic breast cancer (n = 113,987) was divided into data of those who underwent surgery and data of those who refused surgery. Sociodemographic and tumor clinical/pathologic differences were analyzed by multivariate logistic regression of predictors of surgery refusal and Cox-proportional hazard model of disease-specific mortality.

Results

Of 799 patients who refused surgery, 562 were NHB and 237 were Hispanic. The percentage of patients refusing surgery increased from 0.6% in 2005 to 0.9% in 2015. The women who refused surgery were more likely to be older than 81 years, less likely to be married, and more likely to be uninsured or have Medicaid. The refusers presented with more advanced disease and more frequent estrogen receptor-positivity (ER+) and progesterone receptor-positivity (PR+) subtype on histology. Breast cancer-specific mortality increased significantly with surgery omission. Surgery refusal was independently associated with NHB race.

Conclusion

Surgery refusal among NHB and Hispanic women with potentially curable non-metastatic breast cancer is rising, especially among NHB women, women older than 60 years, single women, and women with a later stage of disease at diagnosis. Additional studies are needed to analyze qualitative data in these populations and their underlying health beliefs, communication needs, and possible use of alternative medicine.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA

    Theresa Relation MD, PhD, Yaming Li MD, MS, Samilia Obeng-Gyasi MD, MPH, Mariam F. Eskander MD, MPH, Allan Tsung MD & Bridget A. Oppong MD

  2. College of Medicine, The Ohio State University, Columbus, OH, USA

    Amara Ndumele

  3. Department of Economics, Indiana University Purdue University, Indianapolis, IN, USA

    Oindrila Bhattacharyya MS

  4. The William Tierney Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA

    Oindrila Bhattacharyya MS

  5. James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA

    James L. Fisher PhD

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  1. Theresa Relation MD, PhD
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Correspondence to Bridget A. Oppong MD.

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Relation, T., Ndumele, A., Bhattacharyya, O. et al. Surgery Refusal Among Black and Hispanic Women with Non-Metastatic Breast Cancer. Ann Surg Oncol 29, 6634–6643 (2022). https://doi.org/10.1245/s10434-022-11832-6

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  • DOI: https://doi.org/10.1245/s10434-022-11832-6

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