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Underascertainment of Radiotherapy Receipt in SEER Registry Data
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    SEER registry data has been used to suggest underuse and disparities in receipt of radiotherapy. Prior studies have cautioned that SEER may underascertain radiotherapy but lacked adequate representation to assess whether underascertainment varies by geography or patient sociodemographic characteristics. We sought to determine rates and correlates of underascertainment of radiotherapy in recent SEER data.


    We evaluated data from 2290 survey respondents with nonmetastatic breast cancer, aged 20-79, diagnosed from 6/05-2/07 in Detroit and Los Angeles (LA) and reported to SEER registries (73% response rate). Survey responses regarding treatment and sociodemographic factors were merged to SEER data. We compared radiotherapy receipt as reported by patients versus SEER records. We then assessed correlates of radiotherapy underascertainment in SEER.


    Of 1292 patients who reported receiving radiotherapy, 273 were coded as not receiving radiotherapy in SEER (“underascertained”). Underascertainment was more common in LA than in Detroit (32.0% vs 11.25%, p<0.001). On multivariate analysis, radiotherapy underascertainment was significantly associated in each registry (LA, Detroit) with stage (p=0.008, p=0.026), income (p<0.001, p=0.050), mastectomy receipt (p<0.001, p<0.001), chemotherapy receipt (p<0.001, p=0.045), and diagnosis at a hospital that was not accredited by the American College of Surgeons (p<0.001, p<0.001). In LA, additional significant variables included younger age (p<0.001), non-private insurance (p<0.001), and delayed receipt of radiotherapy (p<0.001).


    SEER registry data as currently collected may not be an appropriate source for documentation of rates of radiotherapy receipt or investigation of geographic variation in the radiation treatment of breast cancer.

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  • Funding:
    K05CA111340/CA/NCI NIH HHS/United States
    N01-PC-35145/PC/NCI NIH HHS/United States
    R01 CA088370/CA/NCI NIH HHS/United States
    CA109696-06/CA/NCI NIH HHS/United States
    K05 CA111340-05/CA/NCI NIH HHS/United States
    N01-PC-35139/PC/NCI NIH HHS/United States
    K05 CA111340/CA/NCI NIH HHS/United States
    R01 CA088370-06/CA/NCI NIH HHS/United States
    R01 CA109696-06/CA/NCI NIH HHS/United States
    U58 DP000807/DP/NCCDPHP CDC HHS/United States
    CA088370-06/CA/NCI NIH HHS/United States
    N01PC54404/CA/NCI NIH HHS/United States
    N01PC35145/CA/NCI NIH HHS/United States
    CA111340-05/CA/NCI NIH HHS/United States
    N01PC35139/CA/NCI NIH HHS/United States
    N01-PC-54404/PC/NCI NIH HHS/United States
    R01 CA109696/CA/NCI NIH HHS/United States
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