Number of People Declining Breast Cancer Treatment is Growing
The percentage of people living in the U.S. who declined hormonal therapy, radiation therapy, and surgery for breast cancer grew between 2004 and 2020, according to a study published in May in the journal JAMA Network Open. People who received treatment were more likely to be alive five and 10 years later than those who declined treatment.
Key Takeaways
Between 2004 and 2020, 9.6% of people with breast cancer declined chemotherapy, 6.1% declined radiation therapy, 5% declined hormonal therapy, and 0.6% declined surgery.
Compared with white people, American Indian, Alaska Native, Asian or Pacific Islander, and Black people were more likely to decline chemotherapy, radiation, or surgery.
People who were Asian or Pacific Islander, Black, and Hispanic were less likely to decline hormonal therapy compared with white people.
People who were older, had a lower income, and had public health insurance (for example, Medicare or Medicaid) or no health insurance were all more likely to decline treatment.
What the results mean for you
You always have the right to decline medical care, but it’s a decision that may impact your long-term health and even survival. In this study, people who received treatment were more likely to be alive five and 10 years after diagnosis than people who refused treatment.
If you’ve been diagnosed with breast cancer and your doctor is recommending a treatment that you don’t feel is in your best interest, it’s important to discuss these feelings with your doctor. If you find talking to your doctor difficult, ask if you can talk to a nurse or patient navigator about treatment. Someone on your healthcare team should be able to explain the benefits and risks of the treatment, as well as possible side effects of the treatment and how these side effects will be managed.
If you still want to decline a treatment, ask your doctor about other options that may be a better fit for your unique situation.
About the study
The researchers looked at the records of nearly 3 million people in the United States who had been treated for breast cancer between 2004 and 2020. More than 99% of the people in the study were women and their average age was about 62 years.
78% were white
11% were Black
6% were Hispanic
3.5% were Asian or Pacific Islander
2% were American Indian, Alaska Native, or other
Nearly half of the people in the study had private health insurance or managed care, 39% had Medicare, and 6% had Medicaid. More than half of the people in the study were diagnosed with stage I breast cancer and 74% were diagnosed with hormone receptor-positive, HER2-negative disease.
Detailed results
Overall, the researchers observed the following trends in people offered breast cancer treatments from 2004 to 2020:
1.97% more people declined hormonal therapy each year
5.62% more people declined radiation therapy each year
11.12% more people declined surgery each year
0.96% fewer people declined chemotherapy each year
American Indian, Alaska Native, Asian or Pacific Islander, and Black people were less likely to decline hormonal therapy than white people. People who were older and lacked health insurance or received Medicaid were also more likely to decline hormonal therapy. People with more advanced stage disease were less likely to decline hormonal therapy.
Compared with white people, Black people were more likely to decline radiation therapy and Hispanic people were less likely to decline radiation. People who were older and lacked health insurance or received Medicaid or Medicare, and had stage II or III cancer were also more likely to decline radiation therapy.
People who were American Indian, Alaska Native, Asian or Pacific Islander, or Black were more likely to decline surgery than white people. In contrast, Hispanic people were less likely to decline surgery. People who were older, received Medicaid or were uninsured, and had more advanced cancer were more likely to decline surgery.
People who identified as American Indian, Alaska Native, or other, Asian or Pacific Islander, or Black were more likely to decline chemotherapy than white people. In contrast, Hispanic people were less likely to decline chemotherapy. People were also more likely to decline chemotherapy if they were older, uninsured or had Medicaid insurance, and had a lower household income and tumor grade. People with more advanced stage disease were less likely to refuse chemotherapy.
Overall, people who received treatment for breast cancer were more likely to be alive five and 10 years later. However, when the researchers broke the groups down by race and ethnicity, they found:
Black people who received chemotherapy, radiation therapy, or surgery had a greater risk of dying than white people who received the same treatment.
Black people who declined chemotherapy had a higher risk of dying than white patients who also declined chemotherapy.
White people who declined surgery had a higher risk of dying than Black people who also declined surgery.
Whether they refused treatment or not, white people had a higher risk of dying than people who were Hispanic, Asian or Pacific Islander, or American Indian, Alaska Native, or from other racial or ethnic groups.
Things to consider about the study
The study highlights ways that race and ethnicity, health insurance, and financial resources may factor into decisions about treatment, the study authors write. However, it doesn’t explain why more people are refusing treatment.
In an invited commentary, the authors suggested a number of reasons why people might say no to treatment, including fear, not understanding the benefits of a treatment, cultural beliefs, mistrust of the healthcare system because of past mistreatment, and financial challenges.
Freeman JQ, et al. Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer. JAMA Netw Open. 2024; 7(5):e249449.
Calip GS, et al. Examining the Associations Among Treatment Declination, Racial and Ethnic Inequities, and Breast Cancer Survival. JAMA Netw Open. 2024; 7(5):e249402.
— Last updated on December 27, 2024 at 7:06 PM