Impact of age on racial disparity in early stage breast cancer in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19058-e19058
Author(s):  
Shruti Bhandari ◽  
Rohit Kumar ◽  
Phuong Ngo ◽  
Sarah Mudra ◽  
Drew Carl Drennan Murray ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Racial Disparity ◽  
Early Stage ◽  
Age Groups ◽  
The United States ◽  
Early Stage Breast Cancer ◽  
Age Group ◽  
Risk Of Mortality ◽  
Younger Age

e19058 Background: Racial disparities persists in women with early stage breast cancer and is most pronounced in Black (B) compared to White (W) women even when controlled for stage and biological subtype. Little is known about the impact of age on racial disparities. Our study evaluates the magnitude of a racial disparity in mortality across age strata in a real-world population. Methods: We identified stage I-III female breast cancer patients between 2010 – 2015 from the National Cancer Database. Hazard ratios (HR) and 95% Confidence Intervals (CI) for all-cause mortality were estimated using multivariable Cox Proportional Hazards regression, adjusted for clinical and demographic factors. The mortality risk for B and Other (O) race was compared to W across four age groups. To determine the significance in excess risk of mortality, the magnitude of disparity of each age group was compared to the > 60y age group. Results: A total of 679,327 patients were included. W comprised the largest percentage across all age groups. However, the percentage of W increased with age, while the percentage of B decreased with age (p < 0.001). The risk of mortality was significantly higher for B relative to W across all age groups ≤60y. When compared to > 60y, the magnitude of effect of age on risk of dying was significantly different (p < 0.0001) (Table). Conversely, the risk of mortality was significantly reduced for O race compared to W, with similar magnitude of effect across all ages. Conclusions: Even after adjusting for known risk factors of racial disparity such as insurance, biologic subtype and stage, the B to W racial disparity in mortality decreased with age (most pronounced in younger age) and appeared to diminish among women > 60 years of age. In contrast, the risk of dying in O race remained constant. Reasons are unclear and may be due to unmeasured socioecomomic or biologic factors that cannot be controlled for in this dataset. Regardless, identifying factors associated with worsened outcomes in younger age groups in B women should be the direction of future studies. [Table: see text]

Increasing Mastectomy Rates Among all Age Groups for Early Stage Breast Cancer: A 10-Year Study of Surgical Choice

2012 ◽  
Vol 18 (4) ◽  
pp. 318-325 ◽  
Author(s):  
Anthony E. Dragun ◽  
Bin Huang ◽  
Thomas C. Tucker ◽  
William J. Spanos
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Age Groups ◽  
Early Stage Breast Cancer

Modeling the consequences of recurrences after trastuzumab treatment of HER2+ early-stage breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12032-e12032
Author(s):  
Quan V. Doan ◽  
Miguel Martin ◽  
Deepa Lalla ◽  
Marc Halperin ◽  
Richard Bryce ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Indirect Costs ◽  
The United States ◽  
Nodal Status ◽  
Early Stage Breast Cancer ◽  
Hourly Wage ◽  
Incident Cases ◽  
Over Time

e12032 Background: The study objective was to estimate the long-term consequences of recurrences following treatment with trastuzumab (TRA) among women with HER2+ early stage breast cancer (BC) in the United States (US). Methods: A simulation model was constructed to estimate the following outcomes for each combination of hormone receptor (+/-) and nodal (+/-) status: number of recurrences, direct medical cost and indirect cost attributed to recurrences. The number of women aged ≥18 years with newly diagnosed HER2+ BC between 2018 and 2037 was estimated using SEER incidence rates (assumed constant over time) and from US Census data and accounted for the proportion of women utilizing adjuvant TRA by nodal status and age (assumed constant over time). The recurrence rate to any regional, distant or contralateral site was based on the long-term follow-up of the HERceptin Adjuvant (HERA) trial (expected 20-year recurrence proportions of 27.6% for TRA and 36.7% without TRA). Medical and pharmacy costs due to a recurrence were based on a 3-year study of metastatic BC patients treated with HER2 targeted agents. Beyond year 3, cost increased by 4.5% per year. The indirect costs of recurrences included loss of income from early retirement valued at the mean hourly wage, work absenteeism ($6,960/year), and reduced productivity while at work ($3,456/year). Non-cancer related mortality was estimated using SEER data. Results: We estimated that there would be 411,373 incident cases of early stage BC who would receive adjuvant TRA treatment from 2018 to 2037. Following each annual cohort for 20 years, we estimated that there would be 112,700 recurrences after TRA treatment and 149,674 recurrences without TRA treatment. The 20-year direct medical costs of recurrences were estimated to be $28.2 and $37.5 billion with and without TRA, respectively and the indirect costs were estimated to be $4.1 and $5.6 billion with and without TRA, respectively. Conclusions: Although TRA reduced recurrences by 25% in our 20-year model, there was a substantial number of recurrences. Future research will assess the clinical and economic impact of newer HER2 directed therapies in the adjuvant (pertuzumab, T-DM1) and extended adjuvant (neratinib) setting.

Financial and employment toxicity related to breast reconstruction following mastectomy in a diverse population-based cohort.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 78-78
Author(s):  
Nicholas L. Berlin ◽  
Adeyiza O. Momoh ◽  
Paul Abrahamse ◽  
Steven J. Katz ◽  
Reshma Jagsi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Employment Status ◽  
Early Stage ◽  
Insurance Coverage ◽  
The United States ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Financial Barriers ◽  
Spanish Speaking

78 Background: Despite mandated private insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed onto women who seek these procedures through cost-sharing arrangements and high-deductible health plans. In this population-based study, we sought to characterize financial and employment toxicities related to pursuing breast reconstruction following mastectomy. Methods: Women (white, African American, and Latina-English and Spanish speaking) with early stage breast cancer (stages 0-II) diagnosed between July 2013 to September 2014 and who underwent mastectomy were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries and surveyed. Primary outcome measures included patient-reported appraisal of financial toxicity and employment status following breast cancer treatment using previously developed measures. Multivariable models evaluated the association between breast reconstruction and self-reported financial and employment status. Results: Among 868 breast cancer patients who underwent mastectomy, 43.5% (n = 378) did not undergo breast reconstruction and 56.5% (n = 490) underwent reconstruction. 43.4% of the cohort reported being worse off financially since their diagnosis (49.4% with reconstruction vs. 35.0% without reconstruction, P< .001). Among women who were employed at time of breast cancer diagnosis (n = 535), 70.2% who underwent reconstruction reported being worse off regarding employment status compared to 51.1% who did not undergo reconstruction ( P< .001). Receipt of reconstruction was independently associated with a self-reported decline in financial status (Odds Ratio (OR) 2.1, 95% Confidence Interval (CI) 1.4-3.4, P= .001). Similarly, reports of being worse off regarding employment status were also higher in those who underwent reconstruction vs. not (OR 2.2, 95% CI 1.2-3.8, P= .006). Spanish-speaking Latina women more often reported being worse off regarding employment status (OR 4.3, 95% CI 2.1-9.0, P< .001) than white women. Conclusions: In this diverse cohort of women who underwent mastectomy for early stage breast cancer, women who elected to undergo reconstruction experienced more self-reported financial and employment toxicities. Patients should be counseled regarding the potential costs related to these procedures. Policy-makers should be aware of the financial barriers for women who undergo reconstruction despite mandatory insurance coverage in the United States.

scholarly journals Decreasing Incidence of Estrogen Receptor-Negative Breast Cancer in the United States: Trends by Race and Region

2021 ◽  
Author(s):  
Brittny C Davis Lynn ◽  
Pavel Chernyavskiy ◽  
Gretchen L Gierach ◽  
Philip S Rosenberg
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Estrogen Receptor ◽  
African American Women ◽  
Breast Cancer Incidence ◽  
Age Groups ◽  
The United States ◽  
Age Group ◽  
Annual Percent Change ◽  
Hispanic White

Abstract Background Incidence of estrogen receptor (ER)-negative breast cancer, an aggressive subtype, is highest in United States (US) African American women and in southern residents but has decreased overall since 1992. We assessed whether ER-negative breast cancer is decreasing in all age groups and cancer registries among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic White (HW) women. Methods We analyzed 17 Surveillance, Epidemiology, and End-Results Program registries (twelve for 1992-2016; five for 2000-2016) to assess NHW, NHB, and HW trends by ER status and age group (30-39, 40-49, 50-69, 70-84 years). We used hierarchical age-period-cohort models that account for sparse data, which improve estimates to quantify between-registry heterogeneity in mean incidence rates and age-adjusted trends versus SEER overall. Results Overall, ER-negative incidence was highest in NHB, then NHW and HW women, and decreased from 1992-2016 in each age group and racial/ethnic group. The greatest decrease was for HW women ages 40-49 years with an annual percent change of –3.5%/year (95% credible interval = −4.4%, −2.7%), averaged over registries. The trend heterogeneity was statistically significant in every race/ethnic and age group. Furthermore, the incidence relative risks by race/ethnicity compared to the race-specific SEER average were also statistically significantly heterogeneous across the majority of registries and age groups (62 of 68 strata). The greatest heterogeneity was seen in HW women, followed by NHB women, and the least in NHW women. Conclusion Decreasing ER-negative breast cancer incidence differs meaningfully by US region and age among NHB and HW women. Analytical studies including minority women from higher and lower incidence areas may provide insights into breast cancer racial disparities.

Prevalence and predictors of second opinions from medical oncologists for early-stage breast cancer: Results from the iCanCare study.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 185-185
Author(s):  
Allison W. Kurian ◽  
Christopher Ryan Friese ◽  
Irina Bondarenko ◽  
Reshma Jagsi ◽  
Steven J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Recurrence Score ◽  
Early Stage Breast Cancer ◽  
Clinical Indication ◽  
P Value ◽  
Medical Oncologists ◽  
Younger Age

185 Background: A second medical oncology opinion (SMO) may facilitate chemotherapy decision-making. However, little is known about the interplay between SMOs, treatment decision-making and chemotherapy use. Methods: We surveyed women newly diagnosed with early-stage invasive breast cancer and treated in 2013-2014 (response rate 70%), accrued approximately 3 months after surgery through 2 population-based SEER registries (Georgia and Los Angeles), about their experiences with medical oncologists, decision-making, and chemotherapy use. We evaluated demographic, clinical and decisional factors associated with SMO using logistic regression, and evaluated the association between SMO and chemotherapy, adjusting for clinical indication for chemotherapy, results of the 21-gene recurrence score assay, and estimated propensity for SMO given patient and tumor-specific characteristics. Results: Among 1182 insured patients who consulted any medical oncologist, 8.7% had SMO and 2.4% received chemotherapy from the SMO provider. On multivariable analysis, predictors of SMO use were younger age (odds ratio, OR 0.97 per year, 95% confidence interval, CI 0.94-0.99), education (college vs. high school graduate, OR 1.88, CI 1.06-3.33), an intermediate 21-gene recurrence score (OR 2.21, CI 1.18-4.16) and a variant of uncertain significance on BRCA1/2 gene testing (OR 5.61, CI 1.22-25.72). Satisfaction with chemotherapy decision-making was high and did not differ between patients who did vs. did not receive SMO (85.3% quite or totally satisfied vs. 86%, p-value 0.85). On multivariable analysis, chemotherapy use did not differ between SMO recipients vs. non-recipients (p-value 0.25). Conclusions: SMO use was low among early-stage breast cancer patients, and was not followed by more or less receipt of chemotherapy. High decision satisfaction regardless of SMO use suggests little unmet demand. Along with younger age and more education, the factor that predicted SMO use was uncertain results of genomic testing. Studies of precision medicine should track patients’ demand for SMO, which may rise with the dissemination of increasingly complex genomic tests. Funding: P01-CA-163233

Impact of African ancestry on the relationship between BMI and survival in early stage breast cancer: Retrospective analysis from E5103.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1010-1010
Author(s):  
Tarah Jean Ballinger ◽  
Guanglong Jiang ◽  
Fei Shen ◽  
Kathy Miller ◽  
Bryan P. Schneider
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Early Stage ◽  
African Ancestry ◽  
Genetic Ancestry ◽  
Early Stage Breast Cancer ◽  
European Ancestry ◽  
A Genome ◽  
The Impact ◽  
The Relationship

1010 Background: Both Black race and obesity are associated with worse survival in early stage breast cancer. Obesity disproportionately affects Black women; however, the degree this contributes to racial disparities in breast cancer remains unclear. Prior work evaluated heterogeneous populations or used self- reported race, rather than genetic ancestry. African ancestry is associated with higher BMI and worse survival in breast cancer; however, the intersection between genetic ancestry and obesity on survival outcomes remains unknown. Methods: We analyzed data from the adjuvant trial E5103. Patients with high risk, HER2 negative breast cancer received doxorubicin/cyclophosphamide x 4, followed by weekly paclitaxel x 12, with or without bevacizumab. Genetic ancestry was determined on the 2,854 patients with available germline DNA, BMI, and outcome data using principal components from a genome-wide array. The primary objective assessed impact of BMI on DFS and OS by ancestry. Multivariate Cox proportional hazard models evaluated correlation between continuous or binary BMI and survival in African (AA) and European (EA) Americans. Results: 13.4% of patients were genetically classified as AA and 86.6% as EA. Higher continuous BMI was significantly associated with worse DFS and OS only in AAs (DFS: HR = 1.25 95% CI 1.07-1.46, p = 0.004; OS: HR = 1.38 95% CI 1.10-1.73, p = 0.005); not in EAs (DFS HR = 0.97 95% CI 0.90-1.05, p = 0.50; OS HR = 1.03 95% CI 0.93-1.14, p = 0.52). By disease subtype, BMI was associated with worse outcomes only in AAs with ER+, and not TNBC. By categorical BMI, WHO class III obesity (³ 40) significantly associated with worse DFS and OS only in AAs (DFS HR = 1.98, p = 0.010; OS HR = 2.07, p = 0.064), not in EAs (DFS HR = 0.97, p = 0.86; OS HR = 1.28, p = 0.30). Proportion of African ancestry (proAA) was associated with higher BMI and worse outcomes in the total population; however, within AAs there was no significant interaction between proAA and BMI on DFS (HR = 0.36, p = 0.06) or OS (HR = 0.38, p = 0.24). In AAs, BMI remained associated with DFS (HR = 2.78, p = 0.019), suggesting higher BMI is associated with worse DFS regardless of proAA. Coefficients for the interaction term indicate that as proAA increases the impact of BMI on outcome is lessened. Conclusions: Higher BMI is significantly associated with worse breast cancer outcomes in women of African ancestry in E5103, but not in those of European ancestry. Categorically, this association was significant only for severe obesity, indicating the relationship may depend on the degree of obesity. As proAA increased in AAs, the impact of BMI on outcome was lessened, suggesting other host factors may contribute more to obesity’s influence on outcome than genetics. Determination of the optimal populations for weight loss interventions will advance precision medicine efforts to impact racial disparities and outcomes in early stage breast cancer.

Community-Based Use of Chemotherapy and Hormonal Therapy for Early-Stage Breast Cancer: 1987-2000

2006 ◽  
Vol 24 (6) ◽  
pp. 872-877 ◽  
Author(s):  
Linda C. Harlan ◽  
Limin X. Clegg ◽  
Jeffrey Abrams ◽  
Jennifer L. Stevens ◽  
Rachel Ballard-Barbash
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Hormonal Therapy ◽  
Early Stage ◽  
The United States ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Community Based ◽  
Node Negative ◽  
Er Positive

Purpose We describe trends in the use of chemotherapy and hormonal therapy by nodal and estrogen receptor (ER) status in women with early-stage breast cancer. Methods Cases were randomly sampled from the population-based Surveillance, Epidemiology and End Results (SEER) program and physician verified treatment was examined. A total of 9,481 women, aged 20 years and older, diagnosed with early-stage breast cancer in 1987 to 1991, 1995, and 2000 were included in the study. Results The use of chemotherapy plus tamoxifen increased between 1995 and 2000 for women with node-negative, ER-positive breast cancer ≥ 1 cm (8% to 21%). Nearly 23% of women with node-negative and ER-positive tumors ≥ 1 cm received no adjuvant therapy. The use of chemotherapy alone increased to nearly 60% in women with node-negative, ER-negative tumors ≥ 1 cm (48% to 59%). However, in 2000, 16% of women with node-positive and ER-negative tumors received no adjuvant therapy and an additional 6% received tamoxifen alone. The influence of age can clearly be seen. Chemotherapy is given much less often in women 70 years or older. Conclusion The results from SEER areas across the United States suggest that physicians quickly responded to publications and guidelines regarding breast cancer therapy. The lack of definitive findings from clinical trials on the use of adjuvant therapy in women 70 years and older may explain the lower use in this group of women.

Sign in / Sign up

Export Citation Format

Share Document