Journal article
Guideline-concordance along the cancer care continuum and breast cancer mortality by race and ethnicity: a SEER-Medicare study
Cancer causes & control, Vol.37(2), p.33
01/21/2026
DOI: 10.1007/s10552-025-02099-9
PMID: 41563590
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.
Details
- Title: Subtitle
- Guideline-concordance along the cancer care continuum and breast cancer mortality by race and ethnicity: a SEER-Medicare study
- Creators
- Emma L Herbach - University of MiamiRyan M Carnahan - University of IowaLauren E McCullough - Emory UniversityBradley D McDowell - University of IowaMichaela Curran - University of IowaKai Wang - University of Iowa, BiostatisticsIngrid M Lizarraga - University of IowaMary E Charlton - University of IowaSarah H Nash - New Mexico Cancer Center
- Resource Type
- Journal article
- Publication Details
- Cancer causes & control, Vol.37(2), p.33
- DOI
- 10.1007/s10552-025-02099-9
- PMID
- 41563590
- NLM abbreviation
- Cancer Causes Control
- ISSN
- 0957-5243
- eISSN
- 1573-7225
- Publisher
- Springer
- Grant note
- P30 CA086862 / NCI NIH HHS
- Language
- English
- Date published
- 01/21/2026
- Academic Unit
- Epidemiology; Biostatistics; Surgery; Nursing; Injury Prevention Research Center; Community and Behavioral Health; Holden Comprehensive Cancer Center
- Record Identifier
- 9985130061602771
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