National Cancer Data Base survey of breast cancer management for patients from low income zip codes

BACKGROUND. The National Cancer Data Base (NCDB), a joint project of the Am erican College of Surgeons Commission on Cancer and the American Cancer Soc iety, is a cancer management and outcomes data base for health care organiz ations. It provides a comparative summary of patient care that is used by p articipating hospitals and communities for self-assessment. The most curren t (1995-1996) breast cancer data on patients from low income zip codes are described here. METHODS, Since 1989, eight Calls for Data have been issued, yielding a tota l of 191,714 reports of non-Hispanic white patients with breast cancer for the years analyzed, 1995-1996. A total of 1961 hospital cancer registries h ave participated in at least one of the Calls for Data. RESULTS. A diverse range of breast cancer cases was reported from a variety of geographic locations and medical care environments. There were general similarities in the treatment of patients from the different income groups; however, some differences were reported. Among patients from lower income zip codes, 60.7% were age 60 years or older, compared with 55.1% from other income zip code groups. The AJCC stage distribution was reported as less f avorable for patients from low income zip codes than for other patients. Th e percentage of patients from low income zip codes diagnosed as Stage 0 or I was 51.2%, compared with 55.9% of patients from the other income zip code s. Of patients from lower income zip codes, 12.1% were reported to have Sta ge III or IV disease, compared with 10.0% of patients from other income zip codes. Patients from low income zip codes received less tissue-sparing sur gery. Of patients from low income zip codes, 14.9% received partial mastect omy with or without radiation or systemic therapy, compared with 18.3% of p atients from other income zip codes. The percentage of patients from low in come zip codes who received a partial mastectomy with axillary lymph node d issection was 23.3% for patients from other income zip codes, the percentag e was 30.5%. Conversely, 49.8% of patients from lower income zip codes rece ived a modified radical mastectomy, compared with 40.5% of patients from ot her income zip codes. CONCLUSIONS. Further improvements in the early diagnosis and surgical treat ment of low income patients can probably he achieved. Programmatic activiti es that further explain or reduce the apparent nonpreferred treatment of so me low income patients should he encouraged. (C) 2000 American Cancer Socie ty.