A Portrait of Breast Cancer in Portugal: The Impact of Racial Disparities.

Abstract

Background Breast cancer is the most common malignancy among women, with racial disparities in diagnosis, tumor characteristics and outcomes. Black women are disproportionately affected by aggressive subtypes and advanced stage disease, influenced by biological, socioeconomic, and healthcare access factors. While these disparities are well-documented globally, their impact in Portugal remains unknown. The Portuguese healthcare system ensures equal access, including for patients from African Portuguese-speaking countries (PALOPs), who face additional challenges due to the medical evacuation process. This study aims to evaluate differences in breast cancer characteristics and treatment delays between black and white women treated at a Portuguese center. Materials and methods A unicentric, retrospective observational study was conducted at a Portuguese center, including 208 women with breast cancer treated between 2022 and 2023. Patients were categorized as black or white, and data were collected on demographic variables, tumor characteristics, stage at diagnosis, and time from symptom onset to treatment initiation. Logistic regression was used to assess the association between the race and breast cancer characteristics. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards models to evaluate survival differences. Results Of the 208 patients, 60 were black and 148 were white. The median age at diagnosis was lower for black women (50 years) compared to white women (64 years). Black women were more likely to be diagnosed at stage III or IV (55% vs. 16.2%, p<0.001). Regarding tumor characteristics, black women had a significantly higher prevalence of grade 3 tumors (30% vs. 12.8%, p=0.005), triple-negative breast cancer (TNBC) (31.7% vs. 11.5%, p<0.001) and lower rates of hormone receptor-positive tumors (58.3% vs. 82.4%, p<0.001). No statistically significant difference was found in HER2 expression between groups. The time from symptom onset to treatment initiation was longer for black women (8.5 months vs. 5 months, p<0.001). However, multiple linear regression indicated that being from a PALOP country, was the main predictor of treatment delays (p=0.013), while race alone was not significant (p=0.341). Overall survival analysis was not feasible. Discussion The findings of this study showed significant disparities in breast cancer between black and white women. Black women were younger at diagnosis, more frequently presented with advanced stage and aggressive subtypes, and experienced longer treatment delays. The longer time from symptom onset to treatment initiation in black women suggests potential barriers to timely healthcare access, including socioeconomic factors and healthcare system navigation challenges. Further analysis suggests that these delays are primarily driven by patients from PALOPs rather than race itself. These patients face additional systemic barriers, including delays in the medical evacuation process and socioeconomic challenges. Conclusion This study highlights the need to address racial disparities in breast cancer care in Portugal. Targeted interventions, policy changes, and improved access to timely care are essential to reducing disparities and improving outcomes.