Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women

Abstract

Purpose To assess tumor subtype distribution and the relative contribution of clinical and sociodemographic factors on breast cancer survival between Hispanic and non-Hispanic whites (NHW). Methods We analyzed data from the California Cancer Registry, which included 29,626 Hispanic and 99,862 NHW female invasive breast cancer cases diagnosed from 2004–2014. Logistic regression was used to assess ethnic differences in tumor subtype, and Cox proportional hazard modeling to assess differences in breast cancer survival. Results Hispanics compared to NHWs had higher odds of having triple negative (OR=1.29; 95% CI, 1.23–1.35) and HER2-overexpressing tumors (OR=1.19; 95% CI, 1.14–1.25 [HR−] and OR=1.39; 95% CI, 1.31–1.48 [HR+]). In adjusted models, Hispanic women had a higher risk of breast cancer mortality than NHW women (mortality rate ratio [MRR]=1.24; 95% CI, 1.19–1.28). Clinical factors accounted for most of the mortality difference (MRR=1.05; 95 % CI, 1.01–1.09); however, neighborhood socioeconomic status (SES) and health insurance together accounted for all of the mortality difference (MRR=1.01; 95% CI, 0.97–1.05). Conclusions Addressing SES disparities, including increasing access to health care, may be critical to overcoming poorer breast cancer outcomes in Hispanics.

An Interactive Resource to Probe Genetic Diversity and Estimated Ancestry in Cancer Cell Lines

“…Several studies have identified an increased proportion of basal-like breast cancers in populations of African ancestry (57)(58)(59)(60)(61). Increased frequency of TNBC has also been observed in the Hispanic/Latino population (62)(63)(64)(65)(66)(67)(68), American Indian/Alaska Native population (64), and women from the Indian subcontinent (69). Interestingly, Filipino women were least likely to have TNBC (69), suggesting a broad range of variability.…”

Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer Is Associated with Indigenous American Ancestry in Latin American Women

“…Multiple studies have shown that while Hispanics/Latinas (Latinas) have lower breast cancer incidence and mortality rates than non-Hispanic White women, they have a higher risk of breast cancer-specific mortality with hazard ratio (HR) estimates ranging from 1.1 to 1.3 (3)(4)(5)(6)(7). This disparity could be in part explained by the fact that Latinas are more likely to be diagnosed with the more aggressive HER2 þ and hormone receptornegative subtypes of the disease than non-Hispanic White women (8)(9)(10)(11)(12)(13)(14)(15).…”

Breast Cancer Outcomes in a Racially and Ethnically Diverse Cohort of Insured Women

“…[4][5][6] Racial disparities in survival may be attributed to both biologic (eg, subtype, tumor characteristics, molecular abnormalities that accelerate progression) and non-biologic factors (eg, socioeconomic status, insurance coverage). [7][8][9] Although recurrence risk by breast cancer subtypes has been examined, surprisingly few studies have included adequate numbers of minority women, particularly from Asian subgroups, precluding evaluation of potential racial/ethnic disparities by biologic subtypes. Previous studies that examined racial/ethnic disparities in breast cancer prognosis were limited by small numbers of breast cancer events, 10 or lacked comprehensive information on breast cancer therapy.…”