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Factors contributing to disparities in early breast cancer treatment
Descriptive
TitleInfo
Title
Factors contributing to disparities in early breast cancer treatment
Name
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NamePart
(type = family)
Chandwani
NamePart
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Sheenu
NamePart
(type = date)
1981-
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Sheenu Chandwani
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(authority = RULIB)
author
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Advisory Committee
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chair
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RHOADS
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GEORGE
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GEORGE RHOADS
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Advisory Committee
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internal member
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Bandera
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Elisa
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Elisa Bandera
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Advisory Committee
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internal member
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Azu
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Michelle
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Michelle Azu
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Advisory Committee
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internal member
Name
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LIN
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YONG
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YONG LIN
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Advisory Committee
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internal member
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Burke
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Thomas
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Thomas Burke
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Advisory Committee
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outside member
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Rutgers University
Role
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(authority = RULIB)
degree grantor
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Graduate School - New Brunswick
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school
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Text
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theses
OriginInfo
DateCreated
(qualifier = exact)
2012
DateOther
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(type = degree)
2012-10
CopyrightDate
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2012
Place
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(type = code)
xx
Language
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(type = code)
eng
Abstract
(type = abstract)
Specific Aims: This dissertation was conducted to examine the following specific aims among early breast cancer patients: 1) Racial differences in the use of pre-operative magnetic resonance imaging (MRI) and the role of pre-operative MRI on rates of re-operation and contralateral prophylactic mastectomy (CPM), and time to surgery; 2) Racial differences in elapsed time and sessions received during radiation therapy; and 3) Racial differences in chemotherapy dose modifications and role of neutropenia in this association. Design, setting and subjects: Subjects were selected from the Breast Cancer Treatment Disparity Study which is an ongoing cohort study of African American (AA) and white subjects residing in eastern New Jersey who were newly diagnosed with early breast cancer between 2005 and 2010. Data were collected through a detailed review of medical records obtained from multiple health care providers of these participants. Results: A significantly higher use of pre-operative MRI among whites versus AAs (58.3% vs. 39.7%, p< 0.01) was seen in the first study. Receipt of pre-operative MRI was associated with a non-significant lower rate of re-operation (RR= 0.76; 95% confidence interval [CI]: 0.54, 1.07), but a significantly higher rate of CPM (RR= 1.75; 95% CI: 1.04, 2.92) and a longer time to surgery (geometric mean= 40.5 days versus 27.6 days, p< 0.01). The second study revealed no differences between AA and white women in elapsed time and sessions received during standard radiation therapy following lumpectomy (median elapsed time= 48 days, % subjects with >49 days elapsed time= 36%, and mean sessions= 33, for both racial groups). In the third study, a significantly lower relative dose intensity (RDI) was delivered to AA subjects than white subjects (94.4% versus 100.0%, p= 0.005) during chemotherapy and the risk of >15% reduction in RDI was more than double (RR= 2.62; 95% CI: 1.40, 4.89) in AA women as compared to white women. White blood cell counts at initiation of chemotherapy and in subsequent cycles were similar between the races and were unable to account for differences in dose intensity between the two groups. Conclusion: The rapid rise in use of pre-operative MRI is a concern as no benefit of its use was observed in this study. We also conclude that once treatment is initiated AA women and white women were very similar in receipt of care delivered during radiation. However, this did not hold true for chemotherapy. AA women in comparison to white women were at more than two-fold risk of experiencing dose modifications during chemotherapy that was not explained by differences in their blood counts.
Subject
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Topic
Public Health
Subject
(authority = ETD-LCSH)
Topic
Breast--Cancer--Treatment--New Jersey
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Title
Rutgers University Electronic Theses and Dissertations
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Identifier
ETD_4194
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electronic resource
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application/pdf
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text/xml
Extent
ix, 123 p. : ill.
Note
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Ph.D.
Note
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Includes bibliographical references
Note
(type = vita)
Includes vita
Note
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by Sheenu Chandwani
Subject
(authority = ETD-LCSH)
Topic
Breast--Cancer--Research--New Jersey
Subject
(authority = ETD-LCSH)
Topic
Breast--Magnetic resonance imaging--New Jersey
Subject
(authority = ETD-LCSH)
Topic
Discrimination in medical care--New Jersey
Identifier
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http://hdl.rutgers.edu/1782.1/rucore10001600001.ETD.000066645
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TitleInfo
Title
Graduate School - New Brunswick Electronic Theses and Dissertations
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rucore19991600001
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NjNbRU
Identifier
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doi:10.7282/T3GQ6WJW
Genre
(authority = ExL-Esploro)
ETD doctoral
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Rights
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The author owns the copyright to this work.
RightsHolder
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Name
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Chandwani
GivenName
Sheenu
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime
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(point = start)
2012-08-16 15:49:47
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Name
Sheenu Chandwani
Role
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Affiliation
Rutgers University. Graduate School - New Brunswick
AssociatedObject
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License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
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DateTime
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2012-10-31
DateTime
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2014-10-31
Type
Embargo
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after October 31st, 2014.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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680960
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