Advertisement

Racial, ethnic and socioeconomic disparities in diagnosis, treatment, and survival of patients with breast cancer

      Highlights

      • Higher stage of breast cancer presentation is correlated with Black race, low socioeconomic status, and no insurance coverage.
      • This correlation with non-White race was compounded for worsening socioeconomic status and lack of insurance coverage.
      • Similar findings were found for survival in breast cancer and rates of breast reconstruction in the United States.

      Abstract

      Background

      The objective of this study was to determine the influence of race/ethnicity and socioeconomic status (SES) on breast cancer outcomes.

      Methods

      A retrospective analysis was performed of Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic patients with non-metastatic breast cancer in the SEER cancer registry between 2007 and 2016.

      Results

      A total of 382,975 patients were identified. On multivariate analysis, NHB (OR 1.18, 95%CI: 1.15–1.20) and Hispanic (OR 1.20, 95%CI: 1.17–1.22) patients were more likely to present with higher stage disease than NHW patients. There was an increased likelihood of not undergoing breast-reconstruction for NHB (OR 1.07, 95%CI: 1.03–1.11) and Hispanic patients (OR 1.60, 95%CI 1.54–1.66). NHB patients had increased hazard for all-cause mortality (HR: 1.13, 95%CI 1.10–1.16). All-cause mortality increased across SES categories (lower SES: HR 1.33, 95%CI 1.30–1.37, middle SES: HR 1.20, 95%CI 1.17–1.23).

      Conclusions

      This population-based analysis confirms worse disease presentation, access to surgical therapy, and survival across racial, ethnic, and socioeconomic factors. These disparities were compounded across worsening SES and insurance coverage.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2020.
        CA A Cancer J Clin. 2020; 70: 7-30
        • Yedjou C.G.
        • Sims J.N.
        • Miele L.
        • et al.
        Health and racial disparity in breast cancer.
        Adv Exp Med Biol. 2019; 1152: 31-49
        • Ko N.Y.
        • Hong S.
        • Winn R.A.
        • Calip G.S.
        Association of insurance status and racial disparities with the detection of early-stage breast cancer.
        JAMA Oncol. 2020 Mar 1; 6: 385-392
        • Warner E.T.
        • Tamimi R.M.
        • Hughes M.E.
        • et al.
        Time to diagnosis and breast cancer stage by race/ethnicity.
        Breast Cancer Res Treat. 2012 Dec; 136: 813-821
        • Lantz P.M.
        • Mujahid M.
        • Schwartz K.
        • et al.
        The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis.
        Am J Publ Health. 2006 Dec; 96: 2173-2178
        • Shoemaker M.L.
        • White M.C.
        • Wu M.
        • Weir H.K.
        • Romieu I.
        Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013.
        Breast Cancer Res Treat. 2018 Jun; 169: 595-606
        • Sergesketter A.R.
        • Thomas S.M.
        • Lane W.O.
        • et al.
        Decline in racial disparities in postmastectomy breast reconstruction: a surveillance, Epidemiology, and End results analysis from 1998 to 2014.
        Plast Reconstr Surg. 2019 Jun; 143: 1560-1570
        • Wirth L.S.
        • Hinyard L.
        • Keller J.
        • Bucholz E.
        • Schwartz T.
        Geographic variations in racial disparities in postmastectomy breast reconstruction: a SEER database analysis.
        Breast J. 2019 Jan; 25: 112-116
        • Onega T.
        • Weiss J.
        • Kerlikowske K.
        • et al.
        The influence of race/ethnicity and place of service on breast reconstruction for Medicare beneficiaries with mastectomy.
        SpringerPlus. 2014; 3: 416
        • Lang J.E.
        • Summers D.E.
        • Cui H.
        • et al.
        Trends in post-mastectomy reconstruction: a SEER database analysis.
        J Surg Oncol. 2013 Sep; 108: 163-168
        • Poulson M.R.
        • Beaulieu-Jones B.R.
        • Kenzik K.M.
        • et al.
        Residential racial segregation and disparities in breast cancer presentation, treatment, and survival.
        Ann Surg. 2021 Jan 1; 273: 3-9
        • Hardy D.
        • Du D.Y.
        Socioeconomic and Racial Disparities in Cancer Stage at Diagnosis, Tumor Size, and Clinical Outcomes in a Large Cohort of Women with Breast Cancer, 2007-2016.
        J Racial Ethn Health Disparities, 2020 Sep 10
        • Yu X.Q.
        Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race.
        BMC Cancer. 2009 Oct 14; 9: 364
        • Curtis E.
        • Quale C.
        • Haggstrom D.
        • Smith-Bindman R.
        Racial and ethnic differences in breast cancer survival: how much is explained by screening, tumor severity, biology, treatment, comorbidities, and demographics?.
        Cancer. 2008 Jan 1; 112: 171-180
        • Bradley C.J.
        • Given C.W.
        • Roberts C.
        Race, socioeconomic status, and breast cancer treatment and survival.
        J Natl Cancer Inst. 2002 Apr 3; 94: 490-496
        • Han Y.
        • Miao Z.-F.
        • Lian M.
        • Peterson L.L.
        • Colditz G.A.
        • Liu Y.
        Racial and ethnic disparities in 21-gene recurrence scores, chemotherapy, and survival among women with hormone receptor-positive, node-negative breast cancer.
        Breast Cancer Res Treat. 2020 Dec; 184: 915-925
        • Akinyemiju T.
        • Moore J.X.
        • Ojesina A.I.
        • Waterbor J.W.
        • Altekruse S.F.
        Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources.
        Breast Cancer Res Treat. 2016 Jun; 157: 575-586
        • Feinglass J.
        • Rydzewski N.
        • Yang A.
        The socioeconomic gradient in all-cause mortality for women with breast cancer: findings from the 1998 to 2006 National Cancer Data Base with follow-up through 2011.
        Ann Epidemiol. 2015 Aug; 25: 549-555
        • Markossian T.W.
        • Hines R.B.
        • Bayakly R.
        Geographic and racial disparities in breast cancer-related outcomes in Georgia.
        Health Serv Res. 2014 Apr; 49: 481-501
        • Ji P.
        • Gong Y.
        • Jiang C.-C.
        • Hu X.
        • Di G.-H.
        • Shao Z.-M.
        Association between socioeconomic factors at diagnosis and survival in breast cancer: a population-based study.
        Cancer Med. 2020 Mar; 9: 1922-1936
        • Lu G.
        • Li J.
        • Wang S.
        • et al.
        The fluctuating incidence, improved survival of patients with breast cancer, and disparities by age, race, and socioeconomic status by decade, 1981-2010.
        Cancer Manag Res. 2018; 10: 4899-4914
        • Warner E.T.
        • Tamimi R.M.
        • Hughes M.E.
        • et al.
        Racial and ethnic differences in breast cancer survival: mediating effect of tumor characteristics and sociodemographic and treatment factors.
        J Clin Oncol Off J Am Soc Clin Oncol. 2015 Jul 10; 33: 2254-2261
        • Han Y.
        • Moore J.X.
        • Langston M.
        • et al.
        Do breast quadrants explain racial disparities in breast cancer outcomes?.
        Cancer Causes Control CCC. 2019 Nov; 30: 1171-1182
        • Velanovich V.
        • Yood M.U.
        • Bawle U.
        • et al.
        Racial differences in the presentation and surgical management of breast cancer.
        Surgery. 1999 Apr; 125: 375-379
        • Simon M.S.
        • Banerjee M.
        • Crossley-May H.
        • Vigneau F.D.
        • Noone A.-M.
        • Schwartz K.
        Racial differences in breast cancer survival in the Detroit Metropolitan area.
        Breast Cancer Res Treat. 2006 May; 97: 149-155
        • Williams F.
        • Thompson E.
        Disparities in breast cancer stage at diagnosis: importance of race, poverty, and age.
        J Health Disparities Res Pract. 2017; 10: 34-45
        • Merkin S.S.
        • Stevenson L.
        • Powe N.
        Geographic socioeconomic status, race, and advanced-stage breast cancer in New York City.
        Am J Publ Health. 2002 Jan; 92: 64-70
        • MacKinnon J.A.
        • Duncan R.C.
        • Huang Y.
        • et al.
        Detecting an association between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures.
        Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2007 Apr; 16: 756-762
        • Dianatinasab M.
        • Mohammadianpanah M.
        • Daneshi N.
        • Zare-Bandamiri M.
        • Rezaeianzadeh A.
        • Fararouei M.
        Socioeconomic factors, health behavior, and late-stage diagnosis of breast cancer: considering the impact of delay in diagnosis.
        Clin Breast Cancer. 2018 Jun; 18: 239-245
        • Yu M.
        • Tatalovich Z.
        • Gibson J.T.
        • Cronin K.A.
        Using a composite index of socioeconomic status to investigate health disparities while protecting the confidentiality of cancer registry data.
        Cancer Causes Control CCC. 2014 Jan; 25: 81-92
        • Abualkhair W.H.
        • Zhou M.
        • Ahnen D.
        • Yu Q.
        • Wu X.-C.
        • Karlitz J.J.
        Trends in incidence of early-onset colorectal cancer in the United States among those approaching screening age.
        JAMA Netw Open. 2020 Jan 3; 3e1920407
        • Kim H.J.
        • Fay M.P.
        • Feuer E.J.
        • Midthune D.N.
        Permutation tests for joinpoint regression with applications to cancer rates.
        Stat Med. 2000 Feb 15; 19: 335-351
        • Guo P.
        • Dai W.
        • Liu S.
        • et al.
        Construction and expression of bivalent membrane-anchored DNA vaccine encoding Sjl4FABP and Sj26GST genes.
        J Huazhong Univ Sci Technol Med Sci Hua Zhong Ke Ji Xue Xue Bao Yi Xue Ying Wen Ban Huazhong Keji Daxue Xuebao Yixue Yingdewen Ban. 2006; 26: 493-496
      1. Incorrect description for basis of household income.
        JAMA. 2015 Jun 9; 313: 2287
        • Rauscher G.H.
        • Allgood K.L.
        • Whitman S.
        • Conant E.
        Disparities in screening mammography services by race/ethnicity and health insurance.
        J Womens Health. 2002; 21 (2012 Feb): 154-160
        • Ahmed A.T.
        • Welch B.T.
        • Brinjikji W.
        • et al.
        Racial disparities in screening mammography in the United States: a systematic review and meta-analysis.
        J Am Coll Radiol JACR. 2017 Feb; 14 (e9): 157-165
        • Dobson R.
        Black women have a higher risk of breast cancer than white women.
        BMJ. 2008 Jan 19; 336: 116.2-11116
        • Gerend M.A.
        • Pai M.
        Social determinants of black-white disparities in breast cancer mortality: a review.
        Cancer Epidemiol Biomarkers Prev. 2008 Nov; 17: 2913-2923
        • Patel S.A.
        • Ng M.
        • Nardello S.M.
        • Ruth K.
        • Bleicher R.J.
        Immediate breast reconstruction for women having inflammatory breast cancer in the United States.
        Cancer Med. 2018 Jul; 7: 2887-2902
        • Morrow M.
        • Mujahid M.
        • Lantz P.M.
        • et al.
        Correlates of breast reconstruction: results from a population-based study.
        Cancer. 2005 Dec 1; 104: 2340-2346
        • Hung M.-C.
        • Ekwueme D.U.
        • Rim S.H.
        • White A.
        Racial/ethnicity disparities in invasive breast cancer among younger and older women: an analysis using multiple measures of population health.
        Cancer Epidemiol. 2016 Dec; 45: 112-118
        • Markides K.S.
        • Coreil J.
        The health of Hispanics in the southwestern United States: an epidemiologic paradox.
        Publ Health Rep. 1986 May-Jun; 101 (PMID: 3086917; PMCID: PMC1477704): 253-265
        • Turra C.M.
        • Elo I.T.
        The impact of salmon bias on the hispanic mortality advantage: new evidence from social security data.
        Popul Res Pol Rev. 2008; 27: 515-530https://doi.org/10.1007/s11113-008-9087-4
        • Obeng-Gyasi S.
        • Bhattacharyya O.
        • Li Y.
        • Eskander M.
        • Tsung A.
        • Oppong B.
        The implications of neighborhood socioeconomic status on surgical management and mortality in malignant phyllodes patients in the Surveillance, Epidemiology, and End Results program.
        Surgery. 2020 Dec; 168: 1122-1127
        • Shariff-Marco S.
        • Yang J.
        • John E.M.
        • et al.
        Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study.
        Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2014 May; 23: 793-811
        • Geronimus A.T.
        To mitigate, resist, or undo: addressing structural influences on the health of urban populations.
        Am J Publ Health. 2000 Jun; 90: 867-872
        • Sighoko D.
        • Murphy A.M.
        • Irizarry B.
        • Rauscher G.
        • Ferrans C.
        • Ansell D.
        Changes in the racial disparity in breast cancer mortality in the ten US cities with the largest African American populations from 1999 to 2013: the reduction in breast cancer mortality disparity in Chicago.
        Cancer Causes Control CCC. 2017 Jun; 28: 563-568
        • Pallok K.
        • De Maio F.
        • Ansell D.A.
        Structural racism - a 60-year-old Black woman with breast cancer.
        N Engl J Med. 2019 Apr 18; 380: 1489-1493
        • Noone A.-M.
        • Lund J.L.
        • Mariotto A.
        • et al.
        Comparison of SEER treatment data with medicare claims.
        Med Care. 2016 Sep; 54: e55-64