Racial disparities in presenting stage and surgical management among octogenarians with breast cancer: a national cancer database analysis.

IF 3 3区 医学 Q2 ONCOLOGY Breast Cancer Research and Treatment Pub Date : 2024-11-04 DOI:10.1007/s10549-024-07531-3
Amulya Vadlakonda, Nikhil L Chervu, Giselle Porter, Sara Sakowitz, Hanjoo Lee, Peyman Benharash, Nimmi S Kapoor
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Abstract

Background: As the US faces a diverse aging population, racial disparities in breast cancer outcomes among elderly patients remain poorly understood. We evaluate the association of race with presenting stage, treatment, and survival of invasive breast cancer among octogenarians.

Methods: Women (≥ 80 years) with invasive breast cancer were identified in 2004-2020 NCDB. To facilitate comparison, only non-Hispanic Black and non-Hispanic White patients were included; patients of Hispanic ethnicity were excluded. Demographics, tumor characteristics, and treatments were assessed by race. Overall survival was compared using the logrank test. Multivariable logistic and Cox proportional hazard regression models were developed to evaluate the independent association of race with outcomes of interest.

Results: Of 222,897 patients, 19,059 (8.6%) were Black. Most patients had stage I ER + HER2- invasive ductal carcinoma. Black patients more frequently had greater comorbidities, low income and education, and advanced stage (p < 0.001 each; ref: White). Following adjustment, Black women had increased likelihood of Stage III/IV over time, as well as increased odds of chemotherapy (AOR 1.22, 95% CI 1.15 - 1.29) and non-operative management (AOR 1.82, 95% CI 1.72 - 1.92; ref: White). Although Black patients had lower survival rates compared to White, race was not associated with 5-year mortality following adjustment for stage, receipt of surgery, and adjuvant treatments (p = 0.34).

Conclusions: Inferior survival among elderly Black patients appears be driven by advanced stage at presentation. While such disparities are narrowing in the present era, future work must consider upstream interventions to ensure equitable outcomes for all races.

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八旬乳腺癌患者在发病分期和手术治疗方面的种族差异:全国癌症数据库分析。
背景:随着美国人口老龄化的加剧,人们对老年乳腺癌患者的种族差异仍然知之甚少。我们评估了种族与八旬老人浸润性乳腺癌的发病阶段、治疗和生存的关系:方法:2004-2020 年国家人口与健康调查(NCDB)中发现了罹患浸润性乳腺癌的女性(≥ 80 岁)。为便于比较,只纳入了非西班牙裔黑人和非西班牙裔白人患者;不包括西班牙裔患者。按种族对人口统计学、肿瘤特征和治疗方法进行了评估。总生存率采用对数秩检验进行比较。建立了多变量逻辑回归模型和考克斯比例危险回归模型,以评估种族与相关结果的独立关联:在 222,897 例患者中,19,059 例(8.6%)为黑人。大多数患者为ER+HER2-浸润性导管癌I期。黑人患者通常合并症较多、收入低、受教育程度低、病情处于晚期(p 结论:黑人患者的生存率较低:老年黑人患者的存活率较低似乎是由发病时的晚期阶段造成的。虽然目前这种差距正在缩小,但未来的工作必须考虑上游干预措施,以确保所有种族都能获得公平的结果。
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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
342
审稿时长
1 months
期刊介绍: Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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