# Evaluating Geographic Variation in Breast Cancer Surgical Outcomes Among Black Women in the US South

> **NIH AHRQ R36** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2020 · $42,488

## Abstract

Abstract
Significance. Surgical treatment by mastectomy or breast conserving surgery (BCS) followed by adjuvant
radiotherapy is recommended for women diagnosed with breast cancer at stages I-III, and receipt of this
guideline concordant care is positively associated with survival. Nearly all women with early stage breast
cancer have surgical treatment. The breast cancer specific mortality disparity that exists between Black and
White women is especially pronounced in certain geographic regions such as the “Black Belt” in US south
including states like North Carolina, Georgia, Mississippi, Alabama and Louisiana, and within these states,
Black women in rural areas have been especially burdened by high cancer morbidity and mortality.
Innovation. Using a unique data linkage between cancer registry data, public and private payer insurance
claims and area level social indicators, this study will be the first large scale quantitative study of the surgical
treatment experience of Black women, and the first in depth investigation of cancer care delivery among rural
Black women specifically. Aims. The objective is to understand patterns in surgical treatment of breast cancer
and resulting costs, complications, complications, and outcomes for Black women residing in urban and rural
areas in the US South. Approach. A cohort of Black women with early stage breast cancer will be derived from
the UNC Cancer Information & Population Health Resource, an innovative data source that links statewide
cancer registry data to multi-payer insurance claims, area level social indicators, and provider factors and
covers 85% of cancers diagnosed in North Carolina between 2004-2013. Aim 1 will use Joinpoint regression to
examine the temporal trends in incident mastectomy and BCS among Black women between 2004 and 2013
and will assess differences in trends for Black women residing in urban vs. rural areas. Aim 2 will assess
whether the difference in prevalence of mastectomy vs BCS between urban and rural areas is mediated by
distance to radiotherapy and use of low procedure volume surgeons using causal inference multiple mediation
techniques. Aim 3 will calculate rate of complications defined as infection, 90-day hospital readmission for
infection, wound complication, and hematoma/seroma and will estimate the costs associated with
complications following surgery. Study Impact. This study integrates several sources of data to identify multi-
level contributors to geographic variation in cancer care outcomes. Greater insight into breast cancer care
delivery for Black women, particularly those in in rural areas, promotes equity in health services delivery. The
long term goal of this study is to identify modifiable systems factors to foster efficient delivery of healthcare,
facilitate the provision of high quality care, and improve patient safety in a vulnerable population especially
burdened by breast cancer.

## Key facts

- **NIH application ID:** 10048394
- **Project number:** 1R36HS027299-01A1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Mya-Lee Roberson
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $42,488
- **Award type:** 1
- **Project period:** 2020-09-30 → 2021-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10048394

## Citation

> US National Institutes of Health, RePORTER application 10048394, Evaluating Geographic Variation in Breast Cancer Surgical Outcomes Among Black Women in the US South (1R36HS027299-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10048394. Licensed CC0.

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