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Guideline-concordance along the cancer care continuum and breast cancer mortality by race and ethnicity: a SEER-Medicare study
Journal article   Open access   Peer reviewed

Guideline-concordance along the cancer care continuum and breast cancer mortality by race and ethnicity: a SEER-Medicare study

Emma L Herbach, Ryan M Carnahan, Lauren E McCullough, Bradley D McDowell, Michaela Curran, Kai Wang, Ingrid M Lizarraga, Mary E Charlton and Sarah H Nash
Cancer causes & control, Vol.37(2), p.33
01/21/2026
DOI: 10.1007/s10552-025-02099-9
PMCID: PMC12823728
PMID: 41563590
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1007/s10552-025-02099-9View
Published (Version of record) Open Access

Abstract

To examine the relationship between guideline-concordant breast cancer care and hazard of cancer death by patient race and ethnicity. We used SEER-Medicare data to identify 212,555 older women diagnosed with invasive breast cancer between 2000 and 2017. Guideline-concordant diagnostic workup, locoregional treatment, and initiation of systemic therapy were defined using NCCN guidelines. Hazards of breast cancer death 2 and 5 years from diagnosis by each guideline-concordance outcome overall and stratified by race and ethnicity were estimated using Cox proportional hazards models. Non-concordant diagnostic workup, locoregional treatment, and systemic therapy initiation were each associated with increased hazards of 2- and 5-year breast cancer mortality (diagnostics HR (95% CI) 1.33 (1.25-1.41), HR 1.29 (1.23-1.35); locoregional HR 2.10 (1.98-2.23), HR 1.83 (1.76-1.90); systemics HR 1.67 (1.51-1.84), HR 1.56 (1.45-1.68)). Non-concordant diagnostic workup and systemic therapy initiation were associated with greater hazard of 2- and 5-year breast cancer death among Black, Asian/Pacific Islander, Hispanic White, and non-Hispanic White patients; there was no consistent association among American Indian/Alaska Native patients for either outcome. Locoregional treatment was strongly associated with hazards of cancer death for all groups. Equitable delivery of guideline-recommended breast cancer care from diagnosis through treatment across racial and ethnic groups may mitigate survival disparities. Efforts to improve access to high-quality care must be informed by and responsive to the social and structural root causes of health inequities.
 Aged Aged, 80 and over Breast Neoplasms - diagnosis Breast Neoplasms - ethnology Breast Neoplasms - mortality Breast Neoplasms - therapy Continuity of Patient Care - standards Continuity of Patient Care - statistics & numerical data Ethnicity - statistics & numerical data Female Guideline Adherence - statistics & numerical data Healthcare Disparities Humans Medicare - statistics & numerical data Practice Guidelines as Topic Racial Groups - statistics & numerical data SEER Program - statistics & numerical data United States - epidemiology UIOWA OA Agreement

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