Nishwant Swami1,2, Tiffany Nguyen3, Edward Christopher Dee4, Idalid Franco5, Yefri A Baez6,7, Kaitlyn Lapen4, Lora Wang8, Neha Goel9, Brandon A Mahal8, Oluwadamilola M Fayanju10,11,12, Narjust Duma13, Fumiko Chino14. 1. University of Massachusetts Chan Medical School, Worcester, MA, USA. 2. Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA. 4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA. 6. Department of Urology, Brigham and Women's Hospital, Boston, MA, USA. 7. Harvard Medical School, Boston, MA, USA. 8. Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA. 9. Department of Surgical Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA. 10. Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA. 11. Rena Rowan Breast Center, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA. 12. Penn Center for Cancer Care Innovation, The University of Pennsylvania, Philadelphia, PA, USA. 13. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. 14. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. chinof@mskcc.org.
Abstract
BACKGROUND: Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups. METHODS: Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status. RESULTS: Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18-1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51-1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease. CONCLUSION: Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.
BACKGROUND: Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups. METHODS: Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status. RESULTS: Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18-1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51-1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease. CONCLUSION: Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.
Authors: Carol E DeSantis; Jiemin Ma; Mia M Gaudet; Lisa A Newman; Kimberly D Miller; Ann Goding Sauer; Ahmedin Jemal; Rebecca L Siegel Journal: CA Cancer J Clin Date: 2019-10-02 Impact factor: 508.702
Authors: Cosette D Champion; Samantha M Thomas; Jennifer K Plichta; Edgardo Parrilla Castellar; Laura H Rosenberger; Rachel A Greenup; Terry Hyslop; E Shelley Hwang; Oluwadamilola M Fayanju Journal: JCO Oncol Pract Date: 2020-10-07
Authors: Paula M Lantz; Mahasin Mujahid; Kendra Schwartz; Nancy K Janz; Angela Fagerlin; Barbara Salem; Lihua Liu; Dennis Deapen; Steven J Katz Journal: Am J Public Health Date: 2006-10-31 Impact factor: 9.308
Authors: Nagi S El Saghir; Muhieddine Seoud; Mazen K Khalil; Maya Charafeddine; Ziad K Salem; Fady B Geara; Ali I Shamseddine Journal: BMC Cancer Date: 2006-07-20 Impact factor: 4.430