We sought to identify socioeconomic (SES) factors associated with adjuvant hormonal therapy (HT) use among a contemporary population of older breast cancer survivors.

Telephone surveys were conducted among women (65–89 years) residing in 4 states (CA, FL, IL, NY) who underwent initial breast cancer surgery in 2003. Demographic, SES, and treatment information was collected.

Of the 2,191 women, 67% received adjuvant HT with either tamoxifen or an aromatase inhibitor (AI); 71% of these women were on an AI. When adjusting for multiple demographic and SES factors, predictors of HT use were: better education (high school degree or higher), better informational/emotional support, and younger age (65 – 79 years). Race/ethnicity, income, and insurance coverage for medication costs were not associated with receiving HT. For those on HT, when adjusting for all other factors, women were more likely to be treated with an AI if they had insurance coverage for some or all medication costs, were wealthier, had better informational/emotional support, and were younger (65 – 69 years).

The majority of older women in this population-based cohort received adjuvant HT and the adoption of AIs was early. Providers should be aware that a woman’s education level and support system influence her decision to take HT. Given the high cost of AIs, its benefits in postmenopausal women with hormone receptor-positive breast cancer, and our finding that women with no insurance coverage for medication costs were significantly less likely to receive an AI, we recommend that policy-makers address this issue.