Breast cancer treatment among women of different ethnicity in Hawaii.

BACKGROUND: An analysis of breast cancer survival for Hawaii's multiethnic women in the 1970s and 1980s showed that Hawaiian and Filipino women experienced a worse survival than their Caucasian and Japanese counterparts even after controlling for stage at diagnosis. We conducted this study to test for ethnic differences in treatment compliance with established guidelines while adjusting for stage at diagnosis and other disease characteristics. METHODS: A total of 406 newly diagnosed breast cancer patients identified through the Hawaii Tumor Registry were available for this project. Two hundred fifty-nine patients of the sample were from Hawaii's predominant fee-for-service multiple private office/community hospital setting and 147 patients were members of a Health Maintenance Organization (HMO). The primary measures assessed were treatment received, ethnicity, age at diagnosis, cancer stage, hormone receptor status, comorbidity, and treatment toxicities. Physician's Data Query (PDQ) guidelines were used as the standard of care. We examined whether there were ethnic-related differences in compliance with PDQ treatment guidelines according to stage at diagnosis. RESULTS: Overall, 25 percent of the sample did not receive treatment that was specifically recommended by PDQ guidelines and 7 percent received treatment that was not recommended by PDQ for the patients' stage of disease. There were no statistically significant ethnic-related differences in compliance with PDQ guidelines. Although not statistically significant, Caucasians and Japanese were less likely than other groups to receive axillary lymph node sampling/dissection and Chinese were more likely than other groups to receive chemotherapy when it was not specifically recommended by the PDQ. There was no difference in adherence to PDQ guidelines between the sample treated in a fee-for-service setting and the sample treated by the HMO. Hawaiians and Chinese experienced lower levels of Grade 3 and 4 chemotherapy-related toxicities than other groups. CONCLUSION: The results of this study do not suggest that treatment compliance with established guidelines differs by ethnicity. Our unexpected finding that Hawaiian and Chinese women experienced lower levels of Grade 3 and 4 chemotherapy-related toxicities deserves further investigation.