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Breast Cancer Quality of Care: Racial & Ethnic Disparities and the Role of Specialization


Despite significant advances that have been made in breast cancer diagnosis and treatment, a disproportionate burden of the disease continues to fall on women from minority groups. Studies suggest that differentials in the quality of breast cancer care in the treatment stage influence breast cancer disparities. Because treatment is defined by medical intervention, the health system plays a critical role in understanding breast cancer disparities and needs to be further examined. Moreover, studies examining such differentials have focused on aggregated racial data, which may be masking smaller ethnic groups that may be at higher risk. This dissertation attempts to clarify the health system contribution to breast cancer quality of care disparities and highlights the need to examine breast cancer quality of care disparities using disaggregated racial/ethnic data in order to help inform the design of more targeted quality improvement efforts.

Paper #1 examines the relationship between designated specialty cancer centers and breast cancer quality of care. In cancer care delivery, there has been an emerging trend for cancer centers to obtain special designations from one or more of the following institutions: the National Cancer Institute (NCI), the National Comprehensive Cancer Network (NCCN), and the American College of Surgeon’ Commission on Cancer. These designations are markers for high quality cancer care, yet little is known about the actual effectiveness of the care they provide or the communities that they tend to serve.

Paper #2 examines breast cancer quality of care differences between Asian women (aggregated and disaggregated) and non-Hispanic White women. Cancer disparities research often focus on examining communities in aggregate. Recently, more scholars are utilizing disaggregated ethnic data when assessing cancer disparities in order to acknowledge the diversity of these large communities. Little is known about breast cancer quality of care disparities among Asian American ethnic groups.

Paper #3 examines the relative contribution of within hospital and between hospital effects on racial/ethnic disparities on the quality of breast cancer treatment. Existing literature posits that there are two mechanisms at the health systems level that contribute to disparities in the quality of care received by minority groups. Some studies suggest that disparities are due to minorities receiving differential treatment within the same institution as White patients, while others propose that minorities tend to receive care from lower quality health care settings. Studies to date have not examined the ways in which the health system may be contributing to breast cancer quality of care disparities.

Data from the California Cancer Registry (CCR) was used for the analyses. The study population consisted of women ages 20 years or older and who have had a first invasive primary breast cancer diagnosis between 2011-2014.

This dissertation contributes to the existing literature on breast cancer disparities by clarifying the mechanism of the health system contribution to breast cancer disparities and uncovering disparities in disaggregated ethnic groups. Findings from this dissertation will provide important information for the development of quality improvement efforts in cancer care delivery.

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