Racial/ethnic and socioeconomic differences in breast cancer surgery performed and delayed treatment: mediating impact on mortality

Abstract

Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quanti ed the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. MethodsWe studied 290,066 women 40 + years old diagnosed with breast cancer between 2010 and 2017 identi ed from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. ResultsNon-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24-1.31] were signi cantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites.Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-speci c mortality (BCSM). Variations in treatment, SES, and clinicopathological factors signi cantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. ConclusionsBridging the gap of access to adequate healthcare services for all to diminish the disproportionate burden of breast cancer would require a multifactorial approach that addresses several biological and social factors that cause these differences.This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results (SEER) research plus 18 registries' specialized census tractlevel SES and rurality dataset released in November 2020. SEER is a cancer surveillance program supported by the National Cancer Institutes (NCI) that serves as the primary source of reliable incidence and survival data in the US. [21]. A detailed database and data collection description can be found elsewhere [21].The study subjects were de-identi ed, and there was no patient contact; thus, the study was exempted from an Institutional Review Board's (IRB) approval.We use SEER*stat version 8.4.0 and identi ed 403,791 women, 40 years old or older, diagnosed with breast cancer as the rst primary cancer between January 2010 and December 2017. From the 403,791 women, our study only included patients who underwent surgery and excluded those who were not recommended for surgery, declined recommended surgery, or had unknown surgery status. In addition, we excluded patients with distant tumor stages, grade IV tumors, and those diagnosed during an autopsy. Lastly, we excluded patients with unknown breast cancer subtypes, tumor grade, tumor stage, tumor site, race, SES, marital status, or rurality. Hence, the sample size used in our analysis was ...

Proportion of thyroid cancer and other cancers in the democratic republic of Congo

“…When we consider both sexes, breast cancer was the most frequent type of cancer in our series, this result being similar to those in the literature[ 29 ].…”

Effect of neighborhood deprivation index on breast cancer survival in the United States

“…In our study, BC patients from affluent neighborhoods received more surgical and radiation treatments which can be explained by the higher percentages of urban areas in these regions with better facilities for treatments, and better referral systems. In a study by Fwelo et al, it was found that Black and Hispanic women were more likely to undergo mastectomy compared to Whites [ 29 ]. This discrepancy could be attributed to the fact that breast cancer is often diagnosed when locally advanced in Black women, indicating limited access to early detection through adequate screening and precluding lumpectomy [ 27 , 29 ].…”

“…In a study by Fwelo et al, it was found that Black and Hispanic women were more likely to undergo mastectomy compared to Whites [ 29 ]. This discrepancy could be attributed to the fact that breast cancer is often diagnosed when locally advanced in Black women, indicating limited access to early detection through adequate screening and precluding lumpectomy [ 27 , 29 ]. Additionally, cultural preferences, low healthcare literacy, and transportation barriers may contribute to limited healthcare access, potentially influencing the decision to avoid radiation treatment [ 27 , 30 ].…”

Digital Health Platforms for Breast Cancer Care: A Scoping Review

“…Goel et al report that a lower neighborhood socioeconomic status is associated with a shorter breast cancer-specific survival, even after controlling for individual sociodemographic, access to care, comorbidities, tumor characteristics, and the National Comprehensive Cancer Network (NCCN) treatment paradigms [46]. Furthermore, non-Hispanic Black patients and Hispanic patients are more likely to undergo mastectomies and receive delayed treatment than non-Hispanic White patients [47]. Digital health platforms can provide important education to patients who may have difficulty accessing care otherwise.…”