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Gandhi S, Nie J, Trevisan M, Attwood K, Freudenheim JL. Social networks, social determinants, and mortality: Western New York Exposures and Breast Cancer study. JNCI Cancer Spectr 2024; 8:pkae057. [PMID: 39018168 PMCID: PMC11288187 DOI: 10.1093/jncics/pkae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/10/2024] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND There are few studies of social support and other social determinants of health after breast cancer diagnosis and their associations with mortality; results have been inconclusive. Further, it is not known if observed associations are specific to women with breast cancer diagnosis or if associations would be similar among healthy women. METHODS Women with incident, pathologically confirmed invasive breast cancer, stage I-IV (n = 1012), and healthy frequency age-matched participants (n = 2036) answered a social support questionnaire in prospective follow-up of a population-based case-control study, the Western New York Exposures and Breast Cancer Study. At interview, all participants were aged 35-79 years and resident of 2 counties in Western New York State. Mortality status was ascertained from the National Death Index. Participants were queried regarding the number of their close friends, frequency of seeing them, household size, household income, and marital status. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer-specific mortality (breast cancer women only) and all-cause mortality were estimated. RESULTS Lower household income was associated with higher all-cause mortality among women diagnosed with breast cancer (HR = 2.48, 95% CI = 1.24 to 4.97) and similarly among the healthy women (HR = 2.63, 95% CI = 1.25 to 5.53). Number and frequency of seeing friends, marital status, and household size were not associated with mortality, either among breast cancer patients or among healthy women. CONCLUSION Among those diagnosed with breast cancer and healthy women, lower income was associated with more than twice the mortality. Marital status, household size, and number or frequency of meeting friends were not associated with survival.
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Affiliation(s)
- Shipra Gandhi
- Roswell Park Comprehensive Cancer Center, Medical Oncology, Buffalo, NY, USA
- State University of New York at Buffalo, Epidemiology and Environmental Health, Buffalo, NY, USA
| | - Jing Nie
- State University of New York at Buffalo, Epidemiology and Environmental Health, Buffalo, NY, USA
| | - Maurizio Trevisan
- College of Health Sciences VinUniversity, Hanoi, Vietnam
- Università Campus Biomedico, Rome, Italy
| | - Kristopher Attwood
- Roswell Park Comprehensive Cancer Center, Medical Oncology, Buffalo, NY, USA
| | - Jo L Freudenheim
- State University of New York at Buffalo, Epidemiology and Environmental Health, Buffalo, NY, USA
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Zeng E, He W, Sjölander A, Bergqvist J, Fang F, Czene K. Familial adversity: association with discontinuation of adjuvant hormone therapy and breast cancer prognosis. J Natl Cancer Inst 2024; 116:920-928. [PMID: 38471102 PMCID: PMC11160492 DOI: 10.1093/jnci/djae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/09/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Many studies have examined patient-related factors affecting adjuvant hormone therapy adherence in patients with breast cancer. Our study aimed to examine associations of family-related factors with adjuvant hormone therapy discontinuation and breast cancer-specific mortality. METHODS By cross-linking 7 Swedish health registers, we performed a cohort study that included all patients with breast cancer who initiated adjuvant hormone therapy during 2006-2019 in Sweden (N = 10 701). A group-based multitrajectory model was used to identify familial adversity groups based on 3 dimensions: material deprivation, negative family dynamics, and loss or threat of loss. Cox proportional hazard models were used to investigate associations of familial adversity with hormone therapy discontinuation and breast cancer-specific mortality. RESULTS We identified 5 distinctive familial adversity groups among the cohort participants. Compared with women who had low familial adversity, higher risks to discontinue adjuvant hormone therapy were observed among women with material deprivation (hazard ratio [HR] = 1.31, 95% confidence interval [CI] = 1.20 to 1.43), negative family dynamics (HR = 1.16, 95% CI = 1.06 to 1.28), loss or threat of loss (HR = 1.15, 95% CI = 1.00 to 1.32), or high familial adversity (HR = 1.53, 95% CI = 1.40 to 1.68). Furthermore, women with material deprivation (HR = 1.37, 95% CI = 1.05 to 1.79), negative family dynamics (HR = 1.41, 95% CI = 1.01 to 1.97), or high adversity (HR = 1.67, 95% CI = 1.26 to 2.23) were at higher risk of dying from breast cancer. CONCLUSION Familial adversity is associated with a higher risk of adjuvant hormone therapy discontinuation and breast cancer-specific mortality. Family-related factors identified in our study may help identify high-risk patients for interventions to prevent treatment discontinuation and subsequently improve breast cancer outcomes.
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Affiliation(s)
- Erwei Zeng
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Chronic Disease Research Institute, The Children’s Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bergqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Bekele BB, Lian M, Schmaltz C, Greever-Rice T, Shrestha P, Liu Y. Preexisting Diabetes and Breast Cancer Treatment Among Low-Income Women. JAMA Netw Open 2024; 7:e249548. [PMID: 38717774 PMCID: PMC11079686 DOI: 10.1001/jamanetworkopen.2024.9548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/26/2024] [Indexed: 05/12/2024] Open
Abstract
IMPORTANCE Diabetes is associated with poorer prognosis of patients with breast cancer. The association between diabetes and adjuvant therapies for breast cancer remains uncertain. OBJECTIVE To comprehensively examine the associations of preexisting diabetes with radiotherapy, chemotherapy, and endocrine therapy in low-income women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included women younger than 65 years diagnosed with nonmetastatic breast cancer from 2007 through 2015, followed up through 2016, continuously enrolled in Medicaid, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. Data were analyzed from January 2022 to October 2023. EXPOSURE Preexisting diabetes. MAIN OUTCOMES AND MEASURES Logistic regression was used to estimate odds ratios (ORs) of utilization (yes/no), timely initiation (≤90 days postsurgery), and completion of radiotherapy and chemotherapy, as well as adherence (medication possession ratio ≥80%) and persistence (<90-consecutive day gap) of endocrine therapy in the first year of treatment for women with diabetes compared with women without diabetes. Analyses were adjusted for sociodemographic and tumor factors. RESULTS Among 3704 women undergoing definitive surgery, the mean (SD) age was 51.4 (8.6) years, 1038 (28.1%) were non-Hispanic Black, 2598 (70.1%) were non-Hispanic White, 765 (20.7%) had a diabetes history, 2369 (64.0%) received radiotherapy, 2237 (60.4%) had chemotherapy, and 2505 (67.6%) took endocrine therapy. Compared with women without diabetes, women with diabetes were less likely to utilize radiotherapy (OR, 0.67; 95% CI, 0.53-0.86), receive chemotherapy (OR, 0.67; 95% CI, 0.48-0.93), complete chemotherapy (OR, 0.71; 95% CI, 0.50-0.99), and be adherent to endocrine therapy (OR, 0.71; 95% CI, 0.56-0.91). There were no significant associations of diabetes with utilization (OR, 0.95; 95% CI, 0.71-1.28) and persistence (OR, 1.09; 95% CI, 0.88-1.36) of endocrine therapy, timely initiation of radiotherapy (OR, 1.09; 95% CI, 0.86-1.38) and chemotherapy (OR, 1.09; 95% CI, 0.77-1.55), or completion of radiotherapy (OR, 1.25; 95% CI, 0.91-1.71). CONCLUSIONS AND RELEVANCE In this cohort study, preexisting diabetes was associated with subpar adjuvant therapies for breast cancer among low-income women. Improving diabetes management during cancer treatment is particularly important for low-income women with breast cancer who may have been disproportionately affected by diabetes and are likely to experience disparities in cancer treatment and outcomes.
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Affiliation(s)
- Bayu Begashaw Bekele
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Min Lian
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Chester Schmaltz
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia
| | | | - Pratibha Shrestha
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
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Kasper G, Momen M, Sorice KA, Mayhand KN, Handorf EA, Gonzalez ET, Devlin A, Brownstein K, Esnaola N, Fisher SG, Lynch SM. Effect of neighborhood and individual-level socioeconomic factors on breast cancer screening adherence in a multi-ethnic study. BMC Public Health 2024; 24:63. [PMID: 38166942 PMCID: PMC10763410 DOI: 10.1186/s12889-023-17252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although mammography can significantly reduce breast cancer mortality, many women do not receive their annual breast cancer screening. Differences in screening adherence exist by race/ethnicity, socioeconomic status (SES), and insurance status. However, more detailed investigations into the impact of neighborhood disadvantage and access to resources on screening adherence are lacking. METHODS We comprehensively examined the effect of individual social, economic, and demographic factors (n = 34 variables), as well as neighborhood level SES (nSES) indicators (n = 10 variables) on breast cancer screening adherence across a multi-ethnic population (n = 472). In this cross-sectional study, participants were surveyed from 2017 to 2018. The data was analyzed using univariate regression and LASSO for variable reduction. Significant predictors were carried forward into final multivariable mixed-effect logistic regression models where odds ratios (OR), 95% confidence intervals and p-values were reported. RESULTS Nineteen percent of participants were non-adherent to breast screening guidelines. Race/ethnicity was not associated with adherence; however, increasing age (OR = 0.97, 95%CI = 0.95-0.99, p = 0.01), renting a home (OR = 0.53, 95%CI = 0.30-0.94, p = 0.04), food insecurity (OR 0.46, 95%CI = 0.22-0.94, p = 0.01), and overcrowding (OR = 0.58, 95% CI = 0.32-0.94, p = 0.01) were significantly associated with lower breast cancer screening adherence. CONCLUSION Socioeconomic indicators at the individual and neighborhood levels impact low breast cancer screening adherence and may help to inform future screening interventions.
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Affiliation(s)
- Gillian Kasper
- Temple University School of Medicine, Philadelphia, PA, USA.
| | - Mahsa Momen
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Kristen A Sorice
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Kiara N Mayhand
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Handorf
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Evelyn T Gonzalez
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Amie Devlin
- Temple University School of Medicine, Philadelphia, PA, USA
| | | | | | - Susan G Fisher
- Temple University School of Medicine, Philadelphia, PA, USA
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Shannon M Lynch
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Kaur M, Patterson A, Molina-Vega J, Rothschild H, Clelland E, Ewing CA, Mujir F, Esserman LJ, Olopade OI, Mukhtar RA. Area Deprivation Index in Patients with Invasive Lobular Carcinoma of the Breast: Associations with Tumor Characteristics and Outcomes. Cancer Epidemiol Biomarkers Prev 2023; 32:1107-1113. [PMID: 37257200 PMCID: PMC10390860 DOI: 10.1158/1055-9965.epi-22-1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Although investigators have shown associations between socioeconomic status (SES) and outcomes in breast cancer, there is a paucity of such data for invasive lobular carcinoma (ILC), the second most common type of breast cancer. Herein we evaluated the relationship between SES with tumor features and outcomes in stage I to III patients with ILC. METHODS We analyzed a prospectively maintained institutional ILC database and utilized the area deprivation index (ADI) to determine neighborhood adversity, an indicator of SES. We used Cox proportional hazards models in Stata 17.0 to evaluate relationships between ADI quintile (Q), race, body mass index (BMI), clinicopathologic features, treatment type, and event-free survival (EFS). RESULTS Of 804 patients with ILC, 21.4% lived in neighborhoods classified as ADI Q1 (least resource-deprived) and 19.7% in Q5 (most resource-deprived). Higher deprivation was significantly associated with larger tumor size (3.6 cm in Q5 vs. 3.1 cm in Q1), increased presence of lymphovascular invasion (8.9% in Q5 vs. 6.7% in Q1), and decreased use of adjuvant endocrine therapy (67.1% in Q5 vs. 73.6% in Q1). On multivariable analysis, tumor size, receptor subtypes, and omission of adjuvant endocrine therapy were associated with reduced EFS. CONCLUSIONS These data show that patients with ILC and higher ADI experience more aggressive tumors and differences in treatment. More data evaluating the complex relationships between these factors is needed to optimize outcomes for patients with ILC, regardless of SES. IMPACT ADI is associated with differences in patients with ILC.
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Affiliation(s)
- Mandeep Kaur
- School of Medicine, University of California, San Francisco, California
| | - Anne Patterson
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California
| | - Julissa Molina-Vega
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California
| | | | - Elle Clelland
- School of Medicine, University of California, San Francisco, California
| | - Cheryl A. Ewing
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California
| | - Firdows Mujir
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California
| | - Laura J. Esserman
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California
| | | | - Rita A. Mukhtar
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, California
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Jackson EB, Simmons CE, Chia SK. Current Challenges and Disparities in the Delivery of Equitable Breast Cancer Care in Canada. Curr Oncol 2023; 30:7263-7274. [PMID: 37623008 PMCID: PMC10453522 DOI: 10.3390/curroncol30080527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Recent exciting advances in the diagnosis and management of breast cancer have improved outcomes for Canadians diagnosed and living with breast cancer. However, the reach of this progress has been uneven; disparities in accessing care across Canada are increasingly being recognized and are at risk of broadening. Members of racial minority groups, economically disadvantaged individuals, or those who live in rural or remote communities have consistently been shown to experience greater challenges in accessing 'state of the art' cancer care. The Canadian context also presents unique challenges-vast geography and provincial jurisdiction of the delivery of cancer care and drug funding create significant interprovincial differences in the patient experience. In this commentary, we review the core concepts of health equity, barriers to equitable delivery of breast cancer care, populations at risk, and recommendations for the advancement of health equity in the Canadian cancer system.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine E. Simmons
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen K. Chia
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Stuart GW, Chamberlain JA, te Marvelde L. The contribution of prognostic factors to socio-demographic inequalities in breast cancer survival in Victoria, Australia. Cancer Med 2023; 12:15371-15383. [PMID: 37458115 PMCID: PMC10417162 DOI: 10.1002/cam4.6092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Breast cancer survival in Australia varies according to socio-economic status (SES) and between rural and urban places of residence. Part of this disparity may be due to differences in prognostic factors at the time of diagnosis. METHODS Women with invasive breast cancer diagnosed from 2008 until 2012 (n = 14,165) were identified from the Victorian Cancer Registry and followed up for 5 years, with death from breast cancer or other causes recorded. A prognostic score, based on stage at diagnosis, cancer grade, whether the cancer was detected via screening, reported comorbidities and age at diagnosis, was constructed for use in a mediation analysis. RESULTS Five-year breast cancer mortality for women with breast cancer who were in the lowest quintile of SES (10.3%) was almost double that of those in the highest quintile (5.7%). There was a small survival advantage (1.7% on average, within each socio-economic quintile) of living in inner-regional areas compared with major cities. About half of the socio-economic disparity was mediated by prognostic factors, particularly stage at diagnosis and the presence of comorbidities. The inner-regional survival advantage was not due to differences in prognostic factors. CONCLUSIONS Part of the socio-economic disparity in breast cancer survival could be addressed by earlier detection in, and improved general health for, more disadvantaged women. Further research is required to identify additional causes of socio-economic disparities as well as the observed inner-regional survival advantage.
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Affiliation(s)
- Geoffrey W. Stuart
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneVictoriaMelbourneAustralia
| | | | - Luc te Marvelde
- Victorian Cancer RegistryCancer Council VictoriaMelbourneVictoriaAustralia
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Johnson G, Miquel-Chambers C, Blas Y, Lowery S, Guerra L, Gonzalez E. Women's Health Maintenance Efforts at a Student-Run Free Clinic in South Florida Exceeded National Trends During the COVID-19 Pandemic. J Community Health 2023; 48:501-507. [PMID: 36719533 PMCID: PMC9887570 DOI: 10.1007/s10900-023-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic posed a setback to health maintenance screenings worldwide. These delays have impacted minorities and those of low socioeconomic status in the same way that disparities in cancer screenings have historically trended. Here, we evaluated the performance of a student-run free clinic in maintaining women up-to-date with cancer screenings before, during, and after the pandemic in relation to national trends. We identified all women eligible for screening mammography and cervical cancer screenings between 2018 and 2022 at the clinic (N = 185). Adequate adherence to screening was defined according to the American Cancer Society (ACS) recommendations for breast mammography, and the United States Preventive Services Task Force (USPSTF) guidelines for cervical cancer screenings. For cervical cancer screening, 166 female patients seen between 2018 and 2022 were eligible, and up-to-date proportions were as follows: 81.3% in 2018; 90.9% in 2019; 83.3% in 2020; 93.3% in 2021; 93.8% in 2022. For breast surveillance, 143 women were eligible for screening mammography, and up-to-date proportions were as follows: 66.7% in 2018; 62.5% in 2019; 91.7% in 2020; 73.1% in 2021; 84.1% in 2022. These proportions were higher than or near national averages.In conclusion, adherence remained steady during the pandemic and was not subject to the declines seen nationally. Our clinic represents an effective model for promoting women's health maintenance and tempering the disparities seen among women of low socioeconomic status.
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Affiliation(s)
- Grace Johnson
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | | | - Yohancie Blas
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Sylea Lowery
- University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Eduardo Gonzalez
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
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Nattinger AB, Bickell NA, Schymura MJ, Laud P, McGinley EL, Fergestrom N, Pezzin LE. Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer. J Clin Oncol 2023; 41:2067-2075. [PMID: 36603178 PMCID: PMC10419674 DOI: 10.1200/jco.22.02012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Poor women with breast cancer have worse survival than others, and are more likely to undergo surgery in low-volume facilities. We leveraged a natural experiment to study the effectiveness of a policy intervention undertaken by New York (NY) state in 2009 that precluded payment for breast cancer surgery for NY Medicaid beneficiaries treated in facilities performing fewer than 30 breast cancer surgeries annually. METHODS We identified 37,822 women with stage I-III breast cancer during 2004-2008 or 2010-2013 and linked them to NY hospital discharge data. A multivariable difference-in-differences approach compared mortality of Medicaid insured patients with that of commercially or otherwise insured patients unaffected by the policy. RESULTS Women treated during the postpolicy years had slightly lower 5-year overall mortality than those treated prepolicy; the survival gain was significantly larger for Medicaid patients (P = .018). Women enrolled in Medicaid had a greater reduction than others in breast cancer-specific mortality (P = .005), but no greater reduction in other causes of death (P = .50). Adjusted breast cancer mortality among women covered by Medicaid declined from 6.6% to 4.5% postpolicy, while breast cancer mortality among other women fell from 3.9% to 3.8%. A similar effect was not observed among New Jersey Medicaid patients with breast cancer treated during the same years. CONCLUSION A statewide centralization policy discouraging initial care for breast cancer in low-volume facilities was associated with better survival for the Medicaid population targeted. Given these impressive results and those from prior research, other policymakers should consider adopting comparable policies to improve breast cancer outcomes.[Media: see text].
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Affiliation(s)
- Ann B. Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Nina A. Bickell
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY
| | - Purushottam Laud
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Emily L. McGinley
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Nicole Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Liliana E. Pezzin
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
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Kumilau R, Hayati F, Liew JES, Sharif SZ, Sahid Nik Lah NA. Short term recurrence and survival rate of breast cancer patients post surgical treatment; north borneo experience. Ann Med Surg (Lond) 2022; 81:104560. [PMID: 36147066 PMCID: PMC9486850 DOI: 10.1016/j.amsu.2022.104560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Breast cancer is the most common cancer among women and one of the major causes of mortality and morbidity worldwide. The aim of this study is to determine two-year cumulative recurrence rates and survival rates and their influential factors among women with breast cancer after surgical treatment. Methods The breast cancer registry with focus on patient's outcome after treatment was retrospectively review for relevant data. The study was started on 2019. All breast cancer patients who underwent surgical procedure between 2016 and 2019 were identified and recruited in this study and was follow up for two year. We performed Kaplan Meier method to determine 2-year recurrence rates and survival rates and compared unadjusted survival statistics using Log-rank test between baseline variables and outcomes. Result From 2016 to 2019, a total of 482 breast cancer patients underwent surgical procedure. The overall observed 2-year recurrence rate among breast cancer patients after surgical treatment was 11.8% (95%CI:8.5,16.4) while for the survival rate was 94.8% (95% CI:91.8,96.7). Log rank test showed that lymph node involvement (p < 0.001) and high lymph node ratio (p < 0.001) were associated with higher cumulative recurrence rates. Meanwhile, stage 4 breast cancer (p = 0.001), higher grade tumour (p = 0.011), larger tumour size (>5 cm) (P = 0.005) and type of tumour (p = 0.018) were demonstrated to have lower survival rates. Conclusion Recurrence rate were significant predictor among patient with lymph node involvement and higher lymph node ratio, while stages of tumour, tumour grade, size of tumour and type of tumour were all highly significant predictor for survival rate. Therefore, the aim for early diagnosis and management of breast cancer is crucial in improving the treatment outcome. The aim of this study is to determine two years cumulative recurrence rates and survival rates and their influential factors among women with breast cancer after surgical treatment in our centre. This is a retrospective cohort study of patients underwent surgical procedure from January 2, 0016 to December 2019. A total of 482 breast cancer patients underwent surgical procedure. The overall observed 2 years recurrence rate among breast cancer patients after surgical treatment was 11.8% (95%CI:8.5,16.4) while for the survival rate was 94.8% (95% CI:91.8,96.7). It showed that lymph node involvement (p < 0.001) and high lymph node ratio (p < 0.001) were associated with higher cumulative recurrence rates.
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Affiliation(s)
- Raynee Kumilau
- Surgical Department, Faculty of Medicine & Health Sciences, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Surgical Department, Faculty of Medicine & Health Sciences, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Corresponding author.
| | - Jerry ES. Liew
- Pharmacy Department, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | | | - Nik Amin Sahid Nik Lah
- Surgical Department, Faculty of Medicine & Health Sciences, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Corresponding author.
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Woods LM, Belot A, Atherton IM, Ellis-Brookes L, Baker M, Ingleby FC. Are deprivation-specific cancer survival patterns similar according to individual-based and area-based measures? A cohort study of patients diagnosed with five malignancies in England and Wales, 2008-2016. BMJ Open 2022; 12:e058411. [PMID: 35688589 PMCID: PMC9189835 DOI: 10.1136/bmjopen-2021-058411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate if measured inequalities in cancer survival differ when using individual-based ('person') compared with area-based ('place') measures of deprivation for three socioeconomic dimensions: income, deprivation and occupation. DESIGN Cohort study. SETTING Data from the Office for National Statistics Longitudinal Study of England and Wales, UK, linked to the National Cancer Registration Database. PARTICIPANTS Patients diagnosed with cancers of the colorectum, breast, prostate, bladder or with non-Hodgkin's lymphoma during the period 2008-2016. PRIMARY AND SECONDARY OUTCOME MEASURES Differentials in net survival between groups defined by individual wage, occupation and education compared with those obtained from corresponding area-level metrics using the English and Welsh Indices of Multiple Deprivation. RESULTS Survival was negatively associated with area-based deprivation irrespective of the type analysed, although a trend from least to most deprived was not always observed. Socioeconomic differences were present according to individually-measured socioeconomic groups although there was an absence of a consistent 'gradient' in survival. The magnitude of differentials was similar for area-based and individually-derived measures of deprivation, which was unexpected. CONCLUSION These unique data suggest that the socioeconomic influence of 'person' is different to that of 'place' with respect to cancer outcomes. This has implications for health policy aimed at reducing inequalities. Further research could consider the separate and additional influence of area-based deprivation over individual-level characteristics (contextual effects) as well as investigate the geographic, socioeconomic and healthcare-related characteristics of areas with poor outcomes in order to inform policy intervention.
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Affiliation(s)
- Laura M Woods
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Aurélien Belot
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Iain M Atherton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Lucy Ellis-Brookes
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Matthew Baker
- National Cancer Research Institute Consumer Forum, London, UK
| | - Fiona C Ingleby
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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12
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Mesa-Eguiagaray I, Wild SH, Bird SM, Williams LJ, Brewster DH, Hall PS, Figueroa JD. Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype. Breast Cancer Res Treat 2022; 194:463-473. [PMID: 35648299 PMCID: PMC9239954 DOI: 10.1007/s10549-022-06632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
Background Women from socio-economically deprived areas are less likely to develop and then to survive breast cancer (BC). Whether associations between deprivation and BC incidence and survival differ by tumour molecular subtypes and mode of detection in Scotland are unknown. Methods Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidence rates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified by the Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derived across seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjusted hazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes for the most versus the least deprived quintile. We adjusted for mode of detection and other confounders. Results In Scotland, screen-detected ER+tumour incidence increased over time, particularly in the least deprived quintile [Average Annual Percentage Change (AAPC) = 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for non-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the least deprived quintile irrespective of ER status (aHR = 1.29 [1.18, 1.41] for ER+ and 1.27 [1.09, 1.47] for ER− tumours). However, deprivation was associated with significantly higher mortality for luminal A and HER2−enriched tumours (aHR = 1.46 [1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker associations for luminal B and TNBC tumours that were not statistically significant. Conclusions Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with higher mortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survival in deprived populations and monitor progress stratified by tumour subtypes and mode of detection. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06632-1.
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Affiliation(s)
- Ines Mesa-Eguiagaray
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sheila M Bird
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Cambridge University's MRC Biostatistics Unit, Cambridge, UK
| | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David H Brewster
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Peter S Hall
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jonine D Figueroa
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK. .,Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
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13
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Medina HN, Callahan KE, Koru-Sengul T, Maheshwari S, Liu Q, Goel N, Pinheiro PS. Elevated breast cancer mortality among highly educated Asian American women. PLoS One 2022; 17:e0268617. [PMID: 35584182 PMCID: PMC9116645 DOI: 10.1371/journal.pone.0268617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Postmenopausal breast cancer (PMBC) is the most commonly diagnosed and the second leading cause of cancer death among women in the US. Research examining the association between PMBC and education level has been inconsistent; no study in the US has examined how educational level impacts PMBC mortality in Asian American women, a largely immigrant population with above-average educational attainment. Methods California Vital Statistics data from 2012–2017 were analyzed to derive age-adjusted mortality rate ratios (MRRs) by education level (associates degree or above referred to as “higher education”, high school, less than high school) and race [Non-Hispanic White (NHW), Asian/Pacific Islander (Asian), and its two largest subpopulations: Chinese and Filipino] from negative binomial regression models. Results PMBC mortality for both NHWs and Asians was greater among women with higher education compared to those who did not complete high school: NHWs had 22% higher PMBC mortality (MRR 1.22; 95% CI: 1.14–1.31) and Asians had 2.6 times greater PMBC mortality (MRR 2.64; 95% CI: 2.32–3.00) than their counterparts who did not complete high school. Asians in the lowest education level had 70% lower mortality than NHWs (MRR 0.30; 95% CI: 0.27–0.34). This mortality advantage among Asians was greatly reduced to only 27% lower among the highest educated (MRR 0.73; 95% CI: 0.68–0.78). For higher educated Filipina women, no mortality advantage was evident compared to NHWs (MRR 0.96; 95% CI: 0.88–1.05). Conclusion PMBC mortality for higher educated Asian women is elevated in comparison to their counterparts with less education. Given that PMBC survival is greater among those with higher education, our findings strongly suggest an excess in the incidence of PMBC (more than double) among higher educated Asian women; this warrants more research into potentially modifiable causes of PMBC in this burgeoning population.
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Affiliation(s)
- Heidy N. Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Karen E. Callahan
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Sfurti Maheshwari
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Qinran Liu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Paulo S. Pinheiro
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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14
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Crown A, Ramiah K, Siegel B, Joseph KA. The Role of Safety-Net Hospitals in Reducing Disparities in Breast Cancer Care. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11576-3. [PMID: 35357616 DOI: 10.1245/s10434-022-11576-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 12/22/2022]
Abstract
Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142-150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.
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Affiliation(s)
- Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Bruce Siegel
- America's Essential Hospitals, Washington, DC, USA
| | - Kathie-Ann Joseph
- Department of Surgery, New York University School of Medicine, NYC Health and Hospitals, Bellevue, New York, NY, USA.
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15
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Socioeconomic Status and Inflammation in Women with Early-stage Breast Cancer: Mediation by Body Mass Index. Brain Behav Immun 2022; 99:307-316. [PMID: 34673177 PMCID: PMC9802182 DOI: 10.1016/j.bbi.2021.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the US, and women of low socioeconomic status (SES) show markedly poorer outcomes than those of high SES. SES may influence health through inflammation, although links between SES and inflammatory biomarkers have not been investigated in women with breast cancer. This study tested the hypothesis that breast cancer patients of lower SES would show higher levels of inflammation than those of higher SES. BMI was examined as a mediator of this association. METHODS Women recently diagnosed with early-stage breast cancer (N = 194) were recruited before neoadjuvant or adjuvant therapy. Participants completed questionnaires and provided blood samples for immune assessment. SES was indexed by participants' self-reported education and annual household income, BMI was determined by height and weight measurements, and blood was assayed for inflammatory biomarkers linked with cancer outcomes: IL-6, CRP, TNF-α, and sTNF-RII. General linear models tested associations between SES and inflammation, and mediation models examined indirect effects through BMI. RESULTS Consistent with hypotheses, education status was associated with CRP, (F(2,185) = 4.72, p = 0.001), and sTNF-RII, (F(2,185) = 4.19, p = 0.02), such that lower education was associated with higher levels of both biomarkers. Further, BMI mediated the associations between education and CRP, (95% CIs [-0.62, -0.11; -0.76, -0.21]), sTNF-RII, (95% CIs [-0.09, -0.01; -0.10, -0.02]), and IL-6, (95% CIs [-0.32, -0.05; -0.38, -0.09]). Annual household income was not significantly associated with inflammation (ps > 0.25), and indirect effects on inflammation through BMI were not significant. CONCLUSIONS Lower education was associated with higher levels of inflammation in this sample, which may presage poor breast cancer-related and clinical outcomes. SES should inform the development of interventions targeting BMI and inflammation in breast cancer.
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16
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Kuehnle E, Siggelkow W, Luebbe K, Schrader I, Noeding KH, Noeding S, Noesselt T, Hillemanns P, Dörk T, Park-Simon TW. First Prospective Cross-Sectional Study on the Impact of Immigration Background and Education in Early Detection of Breast Cancer. Breast Care (Basel) 2021; 16:516-522. [PMID: 34720811 DOI: 10.1159/000511654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Although immigrant health is an important issue in national health policy, there is a serious shortage of data in many countries. Most studies lack information on educational status, which is a major limitation. This prospective cross-sectional study analyzed a real-world breast cancer population on the influence of immigration background and educational status on participation in breast cancer early detection programs in the federal state of Lower Saxony, Germany. Methods Data collection was conducted from 2012 to 2016 in six certified breast cancer centers using a standardized questionnaire for patients' interview and tumor-specific data from the patients' medical records. Results 2,145/3,047 primary breast cancer cases were analyzed. 17.5% of our patients had a history of immigration, including n = 202 first-generation immigrants and n = 168 second-generation immigrants. Most of them were citizens of EU27 member states. No significant difference was seen in age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status compared to the native cohort. 100% participation rate in the breast cancer early detection programs were seen in patients with no school graduation. With regards to the national mammography screening program, participation decreased significantly with educational status (p = 0.0003). Conclusions No tumor biological differences were seen between immigrants and German natives. In first-generation immigrants, early detection programs were well accepted despite sociocultural and language differences. Participation rate decreased significantly with higher education levels irrespective of country of origin. Immigration background does not have a negative effect on the participation in breast cancer screening. This mainly relates to immigrants from EU27 member states.
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Affiliation(s)
- Elna Kuehnle
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wulf Siggelkow
- DIAKOVERE Henriettenstift, Breast Center, Hannover, Germany
| | | | - Iris Schrader
- DIAKOVERE Henriettenstift, Breast Center, Hannover, Germany
| | | | | | | | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
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17
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Sprague BL, Ahern TP, Herschorn SD, Sowden M, Weaver DL, Wood ME. Identifying key barriers to effective breast cancer control in rural settings. Prev Med 2021; 152:106741. [PMID: 34302837 PMCID: PMC8545865 DOI: 10.1016/j.ypmed.2021.106741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/01/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
Breast cancer is the most common cancer and the second most common cause of cancer mortality among women in the United States. Efforts to promote breast cancer control in rural settings face specific challenges. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers, and geographic distance from medical facilities. Women in rural areas have comparable breast cancer mortality rates compared to women in urban settings, but this is due in large part to lower incidence rates and masks a substantial rural/urban disparity in breast cancer survival among women diagnosed with breast cancer. Mammography screening utilization rates are slightly lower among rural women than their urban counterparts, with a corresponding increase in late stage breast cancer. Differences in breast cancer survival persist after controlling for stage at diagnosis, largely due to disparities in access to treatment. Travel distance to treatment centers is the most substantial barrier to improved breast cancer outcomes in rural areas. While numerous interventions have been demonstrated in controlled studies to be effective in promoting treatment access and adherence, widespread dissemination in public health and clinical practice remains lacking. Efforts to improve breast cancer control in rural areas should focus on implementation strategies for improving access to breast cancer treatments.
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Affiliation(s)
- Brian L Sprague
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Thomas P Ahern
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Sally D Herschorn
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Michelle Sowden
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Pathology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Marie E Wood
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
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18
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Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer. Breast Cancer Res Treat 2021; 190:143-153. [PMID: 34405292 DOI: 10.1007/s10549-021-06352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States. METHODS We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database. We assessed the relationship between patient- (e.g., race/ethnicity, stage, age, rurality) and facility-level (e.g., facility type, breast cancer case volume) factors with needle biopsy utilization via a mixed effects logistic regression model controlling for clustering by facility. RESULTS In our cohort of 992,209 patients, 82.96% received needle biopsy. In adjusted models, the odds of needle biopsy receipt were higher for Hispanic (OR 1.04, Confidence Interval 1.01-1.08) and Medicaid patients (OR 1.04, CI 1.02-1.08), and for patients receiving care at Integrated Network Cancer Programs (OR 1.21, CI 1.02-1.43). Odds of needle biopsy receipt were lower for non-metropolitan patients (OR 0.93, CI 0.90-0.96), patients with cancer stage 0 or I (at least OR 0.89, CI 0.86-0.91), patients with comorbidities (OR 0.93, CI 0.91-0.94), and for patients receiving care at Community Cancer Programs (OR 0.84, CI 0.74-0.96). CONCLUSION This study suggests a need to account for sociodemographic factors including rurality as predictors of utilization of evidence-based diagnostic testing, such as needle biopsy. Addressing inequities in breast cancer diagnosis quality may help improve breast cancer outcomes in underserved patients.
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19
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Hines RB, Johnson AM, Lee E, Erickson S, Rahman SMM. Trends in Breast Cancer Survival by Race-Ethnicity in Florida, 1990-2015. Cancer Epidemiol Biomarkers Prev 2021; 30:1408-1415. [PMID: 34210675 DOI: 10.1158/1055-9965.epi-20-1746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period. METHODS This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990 and 2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no). Cumulative incidence estimates of 5- and 10-year breast cancer-related death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution HRs (sHR) for the relative rate of breast cancer death accounting for competing causes. RESULTS Breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement for nearly all metrics compared with non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women, having twice the rate of 5-year [sHR = 2.04; 95% confidence interval (CI), 1.91-2.19] and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-related death. Adjustment for covariates substantially reduced the excess rate of breast cancer-related death for black women. CONCLUSIONS Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, black women continue to experience significant survival disparities. IMPACT These results highlight the need for targeted approaches to eliminate disparities in breast cancer survival for black women.
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Affiliation(s)
- Robert B Hines
- University of Central Florida College of Medicine, Orlando, Florida.
| | - Asal M Johnson
- Stetson University, Public Health Program, Deland, Florida
| | - Eunkyung Lee
- University of Central Florida College of Health Professions and Sciences, Orlando, Florida
| | | | - Saleh M M Rahman
- University of Central Florida College of Medicine, Orlando, Florida
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20
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Zhang Y, Asad S, Weber Z, Tallman D, Nock W, Wyse M, Bey JF, Dean KL, Adams EJ, Stockard S, Singh J, Winer EP, Lin NU, Jiang YZ, Ma D, Wang P, Shi L, Huang W, Shao ZM, Cherian M, Lustberg MB, Ramaswamy B, Sardesai S, VanDeusen J, Williams N, Wesolowski R, Obeng-Gyasi S, Sizemore GM, Sizemore ST, Verschraegen C, Stover DG. Genomic features of rapid versus late relapse in triple negative breast cancer. BMC Cancer 2021; 21:568. [PMID: 34006255 PMCID: PMC8130400 DOI: 10.1186/s12885-021-08320-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) is a heterogeneous disease and we have previously shown that rapid relapse of TNBC is associated with distinct sociodemographic features. We hypothesized that rapid versus late relapse in TNBC is also defined by distinct clinical and genomic features of primary tumors. Methods Using three publicly-available datasets, we identified 453 patients diagnosed with primary TNBC with adequate follow-up to be characterized as ‘rapid relapse’ (rrTNBC; distant relapse or death ≤2 years of diagnosis), ‘late relapse’ (lrTNBC; > 2 years) or ‘no relapse’ (nrTNBC: > 5 years no relapse/death). We explored basic clinical and primary tumor multi-omic data, including whole transcriptome (n = 453), and whole genome copy number and mutation data for 171 cancer-related genes (n = 317). Association of rapid relapse with clinical and genomic features were assessed using Pearson chi-squared tests, t-tests, ANOVA, and Fisher exact tests. We evaluated logistic regression models of clinical features with subtype versus two models that integrated significant genomic features. Results Relative to nrTNBC, both rrTNBC and lrTNBC had significantly lower immune signatures and immune signatures were highly correlated to anti-tumor CD8 T-cell, M1 macrophage, and gamma-delta T-cell CIBERSORT inferred immune subsets. Intriguingly, lrTNBCs were enriched for luminal signatures. There was no difference in tumor mutation burden or percent genome altered across groups. Logistic regression mModels that incorporate genomic features significantly outperformed standard clinical/subtype models in training (n = 63 patients), testing (n = 63) and independent validation (n = 34) cohorts, although performance of all models were overall modest. Conclusions We identify clinical and genomic features associated with rapid relapse TNBC for further study of this aggressive TNBC subset. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08320-7.
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Affiliation(s)
- Yiqing Zhang
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Sarah Asad
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Zachary Weber
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - David Tallman
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - William Nock
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Meghan Wyse
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Jerome F Bey
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Kristin L Dean
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Elizabeth J Adams
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Sinclair Stockard
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Jasneet Singh
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Eric P Winer
- Department of Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy U Lin
- Department of Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Precision Cancer Medicine Center, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, P.R. China
| | - Ding Ma
- Department of Breast Surgery, Precision Cancer Medicine Center, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, P.R. China
| | - Peng Wang
- Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, P.R. China
| | - Leming Shi
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Human Phenome Institute, Fudan University, 2005 Songhu Road, Shanghai, 200438, P.R. China
| | - Wei Huang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai (CHGC) and Shanghai Industrial Technology Institute (SITI), 250 Bibo Road, Shanghai, 201203, P.R. China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Precision Cancer Medicine Center, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, P.R. China
| | - Mathew Cherian
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Maryam B Lustberg
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Bhuvaneswari Ramaswamy
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Sagar Sardesai
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Jeffrey VanDeusen
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Nicole Williams
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Robert Wesolowski
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Samilia Obeng-Gyasi
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Gina M Sizemore
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Steven T Sizemore
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Claire Verschraegen
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Daniel G Stover
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA. .,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA. .,Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA. .,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA. .,Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 512, Columbus, OH, 43210, USA.
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21
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Shariff-Marco S, DeRouen MC, Yang J, Jain J, Nelson DO, Weden MM, Gomez SL. Neighborhood archetypes and breast cancer survival in California. Ann Epidemiol 2021; 57:22-29. [PMID: 33577928 PMCID: PMC8133764 DOI: 10.1016/j.annepidem.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Previous studies on neighborhoods and breast cancer survival examined neighborhood variables as unidimensional measures (e.g. walkability or deprivation) individually and thus cannot inform how the multitude of highly correlated neighborhood domains interact to impact breast cancer survival. Neighborhood archetypes were developed that consider interactions among a broad range of neighborhood social and built environment attributes and examine their associations with breast cancer survival. METHODS Archetypes were measured using latent class analysis (LCA) fit to California census tract-level data. Thirty-nine social and built environment attributes relevant to eight neighborhood domains (socioeconomic status (SES), urbanicity, demographics, housing, land use, commuting and traffic, residential mobility, and food environment) were included. The archetypes were linked to cancer registry data on breast cancer cases (diagnosed 1996-2005 with follow-up through Dec 31, 2017) to evaluate their associations with overall and breast cancer-specific survival using Cox proportional hazards models. Analyses were stratified by race/ethnicity. RESULTS California neighborhoods were best described by nine archetypal patterns that were differentially associated with overall and breast cancer-specific survival. The lowest risk of overall death was observed in the upper middle class suburb (reference) and high status neighborhoods, while the highest was observed among inner city residents with a 39% greater risk of death (95% CI = 1.35 to 1.44). Results were similar for breast cancer-specific survival. Stratified analyses indicated that differences in survival by neighborhood archetypes varied according to individuals' race/ethnicity. CONCLUSIONS By describing neighborhood archetypes that differentiate survival following breast cancer diagnosis, the study provides direction for policy and clinical practice addressing contextually-rooted social determinants of health including SES, unhealthy food environments, and greenspace.
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Affiliation(s)
- Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA.
| | - Mindy C DeRouen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Juan Yang
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| | - Jennifer Jain
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
| | | | | | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Greater Bay Area Cancer Registry, San Francisco, CA
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22
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Afshar N, English DR, Milne RL. Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review. Cancer Control 2021; 28:10732748211011956. [PMID: 33929888 PMCID: PMC8204531 DOI: 10.1177/10732748211011956] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is strong and well-documented evidence that socio-economic inequality in cancer survival exists within and between countries, but the underlying causes of these differences are not well understood. METHODS We systematically searched the Ovid Medline, EMBASE, and CINAHL databases up to 31 May 2020. Observational studies exploring pathways by which socio-economic position (SEP) might causally influence cancer survival were included. RESULTS We found 74 eligible articles published between 2005 and 2020. Cancer stage, other tumor characteristics, health-related lifestyle behaviors, co-morbidities and treatment were reported as key contributing factors, although the potential mediating effect of these factors varied across cancer sites. For common cancers such as breast and prostate cancer, stage of disease was generally cited as the primary explanatory factor, while co-morbid conditions and treatment were also reported to contribute to lower survival for more disadvantaged cases. In contrast, for colorectal cancer, most studies found that stage did not explain the observed differences in survival by SEP. For lung cancer, inequalities in survival appear to be partly explained by receipt of treatment and co-morbidities. CONCLUSIONS Most studies compared regression models with and without adjusting for potential mediators; this method has several limitations in the presence of multiple mediators that could result in biased estimates of mediating effects and invalid conclusions. It is therefore essential that future studies apply modern methods of causal mediation analysis to accurately estimate the contribution of potential explanatory factors for these inequalities, which may translate into effective interventions to improve survival for disadvantaged cancer patients.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Cancer Health Services Research Unit, Centre for Health Policy, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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23
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Abstract
BACKGROUND Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. METHODS A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. RESULTS Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. CONCLUSIONS While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. IMPLICATIONS FOR PRACTICE Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.
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24
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Finke I, Behrens G, Maier W, Schwettmann L, Pritzkuleit R, Holleczek B, Kajüter H, Gerken M, Mattutat J, Emrich K, Jansen L, Brenner H. Small-area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany. Int J Cancer 2021; 149:561-572. [PMID: 33751564 DOI: 10.1002/ijc.33553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 11/12/2022]
Abstract
Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5-year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5-year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14-1.19). For some cancer sites, this association was stronger during short-term follow-up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Werner Maier
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | | | - Michael Gerken
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Johann Mattutat
- Institute for Cancer Epidemiology at the University of Lübeck, Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | | | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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25
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Asad S, Barcenas CH, Bleicher RJ, Cohen AL, Javid SH, Levine EG, Lin NU, Moy B, Niland J, Wolff AC, Hassett MJ, Stover DG. Sociodemographic Factors Associated With Rapid Relapse in Triple-Negative Breast Cancer: A Multi-Institution Study. J Natl Compr Canc Netw 2021; 19:797-804. [PMID: 33691275 DOI: 10.6004/jnccn.2020.7659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) accounts for disproportionately poor outcomes in breast cancer, driven by a subset of rapid-relapse TNBC (rrTNBC) with marked chemoresistance, rapid metastatic spread, and poor survival. Our objective was to evaluate clinicopathologic and sociodemographic features associated with rrTNBC. METHODS We included patients diagnosed with stage I-III TNBC in 1996 through 2012 who received chemotherapy at 1 of 10 academic cancer centers. rrTNBC was defined as a distant metastatic recurrence event or death ≤24 months after diagnosis. Features associated with rrTNBC were included in a multivariable logistic model upon which backward elimination was performed with a P<.10 criterion, with a final multivariable model applied to training (70%) and independent validation (30%) cohorts. RESULTS Among all patients with breast cancer treated at these centers, 3,016 fit the inclusion criteria. Training cohort (n=2,112) bivariable analyses identified disease stage, insurance type, age, body mass index, race, and income as being associated with rrTNBC (P<.10). In the final multivariable model, rrTNBC was significantly associated with higher disease stage (adjusted odds ratio for stage III vs I, 16.0; 95% CI, 9.8-26.2; P<.0001), Medicaid/indigent insurance, lower income (by 2000 US Census tract), and younger age at diagnosis. Model performance was consistent between the training and validation cohorts. In sensitivity analyses, insurance type, low income, and young age were associated with rrTNBC among patients with stage I/II but not stage III disease. When comparing rrTNBC versus late relapse (>24 months), we found that insurance type and young age remained significant. CONCLUSIONS Timing of relapse in TNBC is associated with stage of disease and distinct sociodemographic features, including insurance type, income, and age at diagnosis.
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Affiliation(s)
- Sarah Asad
- Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | | | - Sara H Javid
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Ellis G Levine
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Beverly Moy
- Massachusetts General Hospital, Boston, Massachusetts
| | - Joyce Niland
- City of Hope National Medical Center, Duarte, California; and
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26
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Nattinger AB, Rademacher N, McGinley EL, Bickell NA, Pezzin LE. Can Regionalization of Care Reduce Socioeconomic Disparities in Breast Cancer Survival? Med Care 2021; 59:77-81. [PMID: 33201083 PMCID: PMC7737859 DOI: 10.1097/mlr.0000000000001456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer patients of low socioeconomic status (SES) have worse survival than more affluent women and are also more likely to undergo surgery in low-volume facilities. Since breast cancer patients treated in high-volume facilities have better survival, regionalizing the care of low SES patients toward high-volume facilities might reduce SES disparities in survival. OBJECTIVE We leverage a natural experiment in New York state to examine whether a policy precluding payment for breast cancer surgery for New York Medicaid beneficiaries undergoing surgery in low-volume facilities led to reduced SES disparities in mortality. RESEARCH DESIGN A multivariable difference-in-differences regression analysis compared mortality of low SES (dual enrollees, Medicare-Medicaid) breast cancer patients to that of wealthier patients exempt from the policy (Medicare only) for time periods before and after the policy implementation. SUBJECTS A total of 14,183 Medicare beneficiaries with breast cancer in 2006-2008 or 2014-2015. MEASURES All-cause mortality at 3 years after diagnosis and Medicaid status, determined by Medicare administrative data. RESULTS Both low SES and Medicare-only patients had better 3-year survival after the policy implementation. However, the decline in mortality was larger in magnitude among the low SES women than others, resulting in a 53% smaller SES survival disparity after the policy after adjustment for age, race, and comorbid illness. CONCLUSION Regionalization of early breast cancer care away from low-volume centers may improve outcomes and reduce SES disparities in survival.
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Affiliation(s)
- Ann B. Nattinger
- Department of Medicine
- Center for Advancing Population Science
- Medical College of Wisconsin, Milwaukee, WI
| | | | - Emily L. McGinley
- Center for Advancing Population Science
- Medical College of Wisconsin, Milwaukee, WI
| | - Nina A. Bickell
- Department of Medicine
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Liliana E. Pezzin
- Department of Medicine
- Medical College of Wisconsin, Milwaukee, WI
- Institute for Health and Equity, Milwaukee, WI
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27
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Kressin NR, Battaglia TA, Wormwood JB, Slanetz PJ, Gunn CM. Dense Breast Notification Laws' Association With Outcomes in the US Population: A Cross-Sectional Study. J Am Coll Radiol 2020; 18:685-695. [PMID: 33358722 DOI: 10.1016/j.jacr.2020.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Understanding whether states' breast density notifications are associated with desired effects, or disparities, can inform federal policy. We examined self-reported receipt of personal breast density information, breast density discussions with providers, knowledge about density's masking effect, and association with increased breast cancer risk by state legislation status and women's sociodemographic characteristics. METHODS Cross-sectional observational population-based telephone survey of women aged >40 years who underwent mammography within prior 2 years, had no history of breast cancer, and had heard the term "breast density." RESULTS Among 2,306 women, 57% received personal breast density information. Multivariate regression models adjusted for covariates indicated that women in notification states were 1.5 times more likely to receive density information, and older Black and Asian women of lower income and lower health literacy were less likely. Overall, only 39% of women discussed density with providers; women in notification states were 1.75 times as likely. Older and Asian women were less likely to have spoken with providers; women with high literacy or prior biopsy were more likely. State legislation status was not associated with differences in density knowledge, but Hispanic women and women of lower income or low health literacy had less knowledge regarding density's masking effects; older women were more knowledgeable. Hispanic women and women of lower income or low health literacy were more likely, and middle-aged women less likely, to recognize increased breast cancer risk. DISCUSSION Some positive effects were observed, but sociodemographic disparities suggest tailoring of future breast density communications for specific populations of women to ensure equitable understanding.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Associate Director of the Belkin Breast Health Center, Boston Medical Center, and Director, Women's Health Group, Boston Medical Center
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Priscilla J Slanetz
- Vice Chair of Academic Affairs and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center; President-Elect of the Massachusetts Radiological Society and Chair of the ACR Appropriateness Criteria Committee Breast Imaging Panel; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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28
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Wong FY, Wong RX, Zhou S, Ong WS, Pek PP, Yap YS, Tan BKT, Ngeow JYY, Tan VKM, Sim Y, Tan SM, Lim SH, Madhukumar P, Tan TJY, Loh KWJ, Ong MEH, Wong TH. Effects of housing value and medical subsidy on treatment and outcomes of breast cancer patients in Singapore: A retrospective cohort study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 6:100065. [PMID: 34327401 PMCID: PMC8315650 DOI: 10.1016/j.lanwpc.2020.100065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022]
Abstract
Background Socioeconomic status (SES) is likely to affect survival in breast cancer patients. Housing value is a reasonable surrogate for SES in Singapore where most residents own their own homes, which could be public (subsidised) or private housing. We evaluated effects of housing value and enhanced medical subsidies on patients’ presentation, treatment choices, compliance and survival in a setting of good access to healthcare. Methods A retrospective analysis of breast cancer patients treated in a tertiary hospital cluster from 2000 to 2016 was performed. Individual-level Housing value Index (HI) was derived from each patient's address and then grouped into 3 tiers: HI(high)(minimal subsidy), HI(med)(medium subsidy) and HI(low)(high subsidy). Cox regression was performed to evaluate the associations between overall survival (OS) and cancer-specific survival (CSS) with HI and various factors. Findings We studied a multiracial cohort of 15,532 Stage 0–IV breast cancer patients. Median age was 53.7 years and median follow-up was 7.7 years. Patients with lower HI presented with more advanced disease and had lower treatment compliance. On multivariable analysis, compared to HI(high) patients, HI(med) patients had decreased OS (HR=1.14, 95% CI 1.05–1.23) and CSS (HR=1.15, 95% CI 1.03–1.27), and HI(low) patients demonstrated reduced OS (HR=1.16, 95% CI 1.01–1.33). Ten-year non-cancer mortality was higher in lower HI-strata. Enhanced medical subsidy approximately halved treatment noncompliance rates but its receipt was not an independent prognostic factor for survival. Interpretation Despite good healthcare access, lower-HI patients have poorer survival from both cancer and non-cancer causes, possibly due to delayed health-seeking and poorer treatment compliance. Enhanced subsidies may mitigate socioeconomic disadvantages. Funding None.
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Affiliation(s)
- Fuh Yong Wong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Ru Xin Wong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Siqin Zhou
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Whee Sze Ong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Pin Pin Pek
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Yoon-Sim Yap
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Benita Kiat Tee Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,SingHealth Duke NUS Breast Centre, 11 Hospital Crescent, Singapore, 169610, Singapore.,Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886, Singapore
| | | | - Veronique Kiak Mien Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Yirong Sim
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Su-Ming Tan
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Swee Ho Lim
- KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore, 229899, Singapore
| | - Preetha Madhukumar
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Tira Jing Ying Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Kiley Wei-Jen Loh
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Marcus Eng Hock Ong
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Ting Hway Wong
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
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29
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Statler AB, Wei W, Gupta A, Blake CN, Hobbs BP, Nahleh ZA. Elucidating Determinants of Survival Disparities Among a Real-world Cohort of Metastatic Breast Cancer Patients: A National Cancer Database Analysis. Clin Breast Cancer 2020; 20:e625-e650. [PMID: 32434711 DOI: 10.1016/j.clbc.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disparities in breast cancer survival by race/ethnicity and socioeconomic status have been reported. However, it is unclear if these findings are reproducible among subpopulations. This study aimed to assess if socially oriented factors are predictive of overall survival (OS) among patients with hormone receptor-positive (HR+), human epidermal growth factor 2-positive (HER2+) metastatic breast cancer (MBC). PATIENTS AND METHODS We analyzed patients with MBC included in the National Cancer Database diagnosed with HR+ and HER2+ disease treated between 2010 and 2015. Multivariate analyses describe the association between non-clinical prognostic factors and OS. A matched analysis, which balanced prognostic factors between whites and African Americans (AA), was also conducted. RESULTS Of the 6200 patients analyzed, the majority were 50 years or older, white, and treated with hormonal therapy. Disparities in OS were observed; multivariate analysis revealed diminished survival was associated with low income (< $38K vs. ≥ $63K, hazard ratio [HR], 1.30; P < .001), having government insurance (government vs. private, HR, 1.55; P < .001), living closer to one's treatment facility (< 4 miles vs. ≥ 18 miles, HR, 1.16; P = .04), and being AA (AA vs. white, HR, 1.20; P = .006). The mortality disparity attributed to race was insignificant in the matched analysis (AA vs. white, HR, 1.13; 95% confidence interval, 0.98-1.30; P = .09). CONCLUSIONS This study confirms that the known sociodemographic disparities in OS among patients with MBC are similar within the HR+/HER2+ subpopulation. The discordance of outcomes between matched and unmatched analysis demonstrate that there is a highly vulnerable subgroup of AAs. Further investigation is required to determine if the identified associations are independently causal of poor prognosis.
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Affiliation(s)
- Abby B Statler
- Cancer Biostatistics, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Wei Wei
- Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Annie Gupta
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL
| | - Cassann N Blake
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL
| | - Brian P Hobbs
- Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Zeina A Nahleh
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL.
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Accordino MK, Wright JD, Buono D, Lin A, Huang Y, Neugut AI, Hillyer GC, Hershman DL. Incidence and Predictors of Diabetes Mellitus after a Diagnosis of Early-Stage Breast Cancer in the Elderly Using Real-World Data. Breast Cancer Res Treat 2020; 183:201-211. [PMID: 32591988 PMCID: PMC8403515 DOI: 10.1007/s10549-020-05756-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The incidence and predictors of diabetes (DM) in patients with breast cancer (BC) were evaluated. We compared DM incidence and physician access in BC patients to matched controls. METHODS We identified women with stage I-III BC diagnosed from 2005 to 2013 in the SEER-Medicare database, with ≥ 2 years of follow-up after diagnosis, without previous DM claims. Incident DM was determined by ≥ 1 DM claims after BC diagnosis. Multivariable analysis was used to identify factors associated with incident DM. Age- and race-matched non-cancer controls were obtained from a 5% random sample and assigned an index date. Physician and PCP visits per-patient-per-year were compared between cases and controls in the two-year period prior to and after the index date. RESULTS Among 14,506 eligible BC patients, 3234 (22.3%) developed DM versus 16.5% of controls. Among BC patients, factors associated with incident DM included race (Black OR 1.63 95% CI 1.39-1.93, Hispanic OR 3.03 95% CI 1.92-4.81; vs. Caucasians), SES (Quintile 0 vs. Quintile 4 OR 1.55 95% CI 1.33-1.78), and receipt of chemotherapy (vs. none OR 1.19 95% CI 1.08-1.31). Among cases and controls, respectively, median physician visits per-patient-per-year were 19 and 17 prior to the index date, and 46 and 19 after the index date; median PCP visits were 2 for both groups in both periods. CONCLUSION About 22% of BC patients developed DM, more than controls in the same period. While there were differences in healthcare access, there weren't differences in PCP access between groups. This represents an opportunity for better comorbidity management in BC patients.
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Affiliation(s)
- Melissa K Accordino
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Jason D Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Donna Buono
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Aijing Lin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Grace C Hillyer
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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31
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Kyanko KA, Hoag J, Busch SH, Aminawung JA, Xu X, Richman IB, Gross CP. Dense Breast Notification Laws, Education, and Women's Awareness and Knowledge of Breast Density: a Nationally Representative Survey. J Gen Intern Med 2020; 35:1940-1945. [PMID: 31916210 PMCID: PMC7351910 DOI: 10.1007/s11606-019-05590-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date, 38 states have enacted dense breast notification (DBN) laws mandating that mammogram reports include language informing women of risks related to dense breast tissue. OBJECTIVE Nationally representative survey to assess the association between residing in a state with a DBN law and women's awareness and knowledge about breast density, and breast cancer anxiety. DESIGN Internet survey conducted in 2018 with participants in KnowledgePanel®, an online research panel. PARTICIPANTS English-speaking US women ages 40-59 years without a personal history of breast cancer who had received at least one screening mammogram (N = 1928; survey completion rate 68.2%). MAIN MEASURES (1) Reported history of increased breast density, (2) knowledge of the increased risk of breast cancer with dense breasts, (3) knowledge of the masking effect of dense breasts on mammography, and (4) breast cancer anxiety. KEY RESULTS Women residing in DBN states were more likely to report increased breast density (43.6%) compared with women residing in non-DBN states (32.7%, p < 0.01, adjusted odds ratio, 1.70, 95% CI,1.34-2.17). Interaction effect between DBN states and education status showed that the impact of DBN on women's reporting of dense breasts was significant for women with greater than high school education, but not among women with a high school education or less (p value = 0.01 for interaction). Only 23.0% of women overall knew that increased breast density was associated with a higher risk of breast cancer, and 68.0% of women understood that dense breasts decreased the sensitivity of mammography. There were no significant differences between women in DBN states and non-DBN states for these outcomes, or for breast cancer-related anxiety. CONCLUSIONS State DBN laws were not associated with increased understanding of the clinical implications of breast density. DBN laws were associated with a higher likelihood of women reporting increased breast density, though not among women with lower education.
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Affiliation(s)
- Kelly A Kyanko
- Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
| | | | | | | | - Xiao Xu
- Yale School of Medicine, New Haven, CT, USA
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Mahumud RA, Alam K, Keramat SA, Renzaho AMN, Hossain MG, Haque R, Ormsby GM, Dunn J, Gow J. Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: a pooled decomposition analysis. ACTA ACUST UNITED AC 2020; 78:32. [PMID: 32528677 PMCID: PMC7285540 DOI: 10.1186/s13690-020-00410-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022]
Abstract
Background Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities. Methods A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008-09 to 2016). Results The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services. Conclusions The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.
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Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW Australia.,Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, 1212 Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia
| | - Syed Afroz Keramat
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, 1212 Bangladesh
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW Australia
| | - Md Golam Hossain
- Health and Epidemiological Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205 Bangladesh
| | - Rezwanul Haque
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, 1212 Bangladesh
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of southern Queensland, Toowoomba, QLD 4350 Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD 4006 Australia.,Prostate Cancer Research Foundation of Australia, St Leonards, NSW 2065 Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000 South Africa
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33
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Abdou Y, Attwood K, Cheng TYD, Yao S, Bandera EV, Zirpoli GR, Ondracek RP, Stein L, Bshara W, Khoury T, Ambrosone CB, Omilian AR. Racial differences in CD8 + T cell infiltration in breast tumors from Black and White women. Breast Cancer Res 2020; 22:62. [PMID: 32517730 PMCID: PMC7285742 DOI: 10.1186/s13058-020-01297-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background African American/Black women with breast cancer have poorer survival than White women, and this disparity persists even after adjusting for non-biological factors. Differences in tumor immune biology have been reported between Black and White women, and the tumor immune milieu could potentially drive racial differences in breast cancer etiology and outcome. Methods We examined the association of CD8+ cytotoxic T cells with clinical-pathological variables in the Women’s Circle of Health Study (WCHS) population of predominantly Black breast cancer patients. We evaluated 688 invasive breast tumor samples (550 Black, 138 White) using immunohistochemical staining of tissue microarray slides. CD8+ T cells were scored for each patient tumor sample with digital image analysis. Results Black women had a significantly higher percentage of high-grade, estrogen receptor (ER)-negative, and triple-negative tumors than White women and significantly higher CD8+ T cell density (median 87.6/mm2 vs. 53.1/mm2; p < 0.001). Within the overall population and in the population of Black women only, CD8+ T cell density was significantly higher in younger patients and patients with high-grade and ER/PR-negative tumors. No significant associations were observed between CD8+ T cell density and overall survival or breast cancer-specific survival in the overall population, or when Black patients were analyzed as a separate group. However, when stratified by subtype, Black women with triple-negative breast cancer and high CD8+ T cell density showed a trend towards better overall survival in comparison with patients with low CD8+ T cell density (HR = 0.51; 95% CI 0.25–1.04). Conclusions Our data raise the possibility that distinct mechanisms of immune cell action may occur in different racial groups.
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Affiliation(s)
- Yara Abdou
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ting-Yuan David Cheng
- Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elisa V Bandera
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.,Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Gary R Zirpoli
- Slone Epidemiology Center, Boston University Medical Campus, Boston, MA, USA
| | - Rochelle Payne Ondracek
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Leighton Stein
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Wiam Bshara
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Angela R Omilian
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
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Survival Rate of Breast Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis. Ann Glob Health 2019; 85:138. [PMID: 31857944 PMCID: PMC6896839 DOI: 10.5334/aogh.2521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Breast cancer (BC) is one of the main problems of public health around the world. As a consequence, survival rates are one of the most salient indicators for assessing the quality of cancer control and treatment programs. Objectives: The aim of this study is to evaluate the survival rate of breast cancer in the Eastern Mediterranean region at different periods of time. Methods: Medline/PubMed, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar databases until February 1, 2018. All observational studies (cross-sectional, case-control, and cohort) referring to the survival of breast cancer were included in the study. The heterogeneity and its value were examined by Cochran test and I2 statistics, respectively. Analysis of subgroups performed was based on geographical area and Human Development Index (HDI), using Stata 12 software. Findings: A total of 58 papers were analyzed. Based on a random effect model, the survival rates of breast cancer in different periods—1, 2, 3, 4, 5 and 10 years—were estimated at 93.9, 85, 79.8, 72.6, 69.2, 62.1 and 55.5 percent, respectively. The highest 10-year survival rate was in Iran (59.2%), and the lowest was observed in Bahrain (45%). Conclusions: Evidence suggests that about half of the patients in this area would die before 10 years survival, which is different from more developed countries. Also, high survival rates are associated with high human development index, which can help health policy-makers to better predict the outcomes of patients.
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35
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Rey-Vargas L, Sanabria-Salas MC, Fejerman L, Serrano-Gómez SJ. Risk Factors for Triple-Negative Breast Cancer among Latina Women. Cancer Epidemiol Biomarkers Prev 2019; 28:1771-1783. [DOI: 10.1158/1055-9965.epi-19-0035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
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Jerome-D'Emilia B, Suplee P, Kushary D. A 10-Year Evaluation of New Jersey's National Breast and Cervical Cancer Early Detection Program: Comparison of Stage at Diagnosis in Enrollees and Nonenrollees. J Womens Health (Larchmt) 2019; 29:230-236. [PMID: 31436495 DOI: 10.1089/jwh.2019.7724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The New Jersey Cancer Education and Early Detection (NJCEED) program provides breast cancer screening to low income, uninsured, and underinsured women. The purpose of this study was to evaluate the effectiveness of the NJCEED program by considering stage at diagnosis for women enrolled in NJCEED compared to women diagnosed in the state of New Jersey who were not enrollees. Materials and Methods: The sample included 47,162 women diagnosed with breast cancer; of those, 1,364 women were NJCEED enrollees. Enrollees were significantly different from nonenrollees in age, race, ethnicity, education, and poverty level. Results: In the logistic regression, NJCEED enrollees had 88.3% higher odds of being diagnosed at a late stage compared with nonenrollees (odds ratio [OR]: 1.883, confidential interval [CI]: 1.678-2.109). African American women had 54.9% higher odds of being diagnosed at a later stage (OR: 1.549, CI: 1.457-1.646). The likelihood of a late stage diagnosis increased as poverty level increased. Conclusion: These results were consistent with other National Breast and Cervical Cancer Early Detection Program state evaluations, and with evaluations of the national program. Providing a free screening service is not in itself adequate to encourage screening in low-income uninsured women.
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Affiliation(s)
| | - Patricia Suplee
- Rutgers School of Nursing-Camden, Rutgers University, Camden, New Jersey
| | - Debashis Kushary
- Rutgers University, School of Arts and Sciences, Camden, New Jersey
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TAHERI M, TAVAKOL M, AKBARI ME, ALMASI-HASHIANI A, ABBASI M. Relationship of Socio Economic Status, Income, and Education with the Survival Rate of Breast Cancer: A Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1428-1438. [PMID: 32292725 PMCID: PMC7145923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite our awareness of the significant effect of Social Determinant of Health (SDoH) such as Socio Economic Status (SES), income and education on breast cancer survival, there was a serious lack of information about the effect of different level of these factors on breast cancer survival. So far, no meta-analysis has been conducted with this aim, but this gap was addressed by this meta-analysis. METHODS Main electronic databases such as PubMed, Web of Science, and Scopus were investigated up to January 2019. Epidemiological studies focusing on the association between SDoH and breast cancer were singled out. Q-test and I2 statistic were used to study the heterogeneity across studies. Begg's and Egger's tests were applied to explore the likelihood of the publication bias. The results were reported as hazard ratio (HR) with 95% confidence intervals (CI) through a random-effects model. RESULTS We identified 7,653 references and included 25 studies involving 1,497,881 participants. The HR estimate of breast cancer survival was 0.82 (0.67, 0.98) among high level of SES, 0.82 (0.70, 0.94) among high level of income and 0.72 (0.66, 0.78) among academic level of education. CONCLUSION The SES, income, and education were associated with breast cancer survival, although the association was not very strong. However, there was a significant association between the levels of these factors and breast cancer survival.
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Affiliation(s)
- Majid TAHERI
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad TAVAKOL
- Department of Sociology, School of Social Sciences, University of Tehran, Tehran, Iran
| | | | - Amir ALMASI-HASHIANI
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran,Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Mahmoud ABBASI
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author:
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Riba LA, Gruner RA, Alapati A, James TA. Association between socioeconomic factors and outcomes in breast cancer. Breast J 2019; 25:488-492. [PMID: 30983100 DOI: 10.1111/tbj.13250] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent socioeconomic disparities are evident in the delivery of health care. Despite previous research into health disparities, the extent of the effect of economic inequalities in the management of breast cancer is not well understood. The purpose of our study is to perform a national assessment of the impact of economic factors on key aspects of breast cancer management. METHODS This is a retrospective study using data from the National Cancer Database. The population consisted of female patients with primary breast cancer diagnosed between 2011 and 2015. Patients were categorized based on household income and insurance status. Outcomes investigated were stage at diagnosis, rate of breast conservation therapy, use of immediate reconstruction following mastectomy, and administration of systemic therapy for stage 3 and 4 disease. Multivariable logistic regression analyses were performed to determine significant associations between economic factors and clinical outcomes. Survival analysis was performed to evaluate the influence of income and insurance on survival. RESULTS In total, 666 487 women were evaluated. Multivariable regression analyses revealed that patients with lower income (OR, 1.23) and no insurance (OR, 1.64) were more often diagnosed with later stage disease. Patients with lower income (OR, 1.08) and no insurance (OR, 1.05) had a higher likelihood of undergoing mastectomy instead of breast conserving therapy. Patients with lower income (OR, 0.51) and no insurance (OR, 0.27) were less likely to receive immediate breast reconstruction. Administration of systemic therapy was less frequent in patients with lower income (OR, 0.90) and no insurance (OR, 0.52). A survival benefit was demonstrated in patients with high income and insurance. CONCLUSION Our findings demonstrate prevailing disparities in the delivery of care among patients with limited economic resources, which pertains to some of the most important aspects of breast cancer care. The full etiology of the observed disparities is complex and multifactorial, and a better understanding of these issues offers the potential to close the existing gap in quality of care.
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Affiliation(s)
- Luis A Riba
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ryan A Gruner
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amulya Alapati
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ted A James
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Binboga E, Binboga S. A comparison of the excision methods in breast lesions of classic wire localisation and the advanced breast biopsy system of breast lesion excision system. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Li J, Cornacchi SD, Farrokhyar F, Johnston N, Forbes S, Reid S, Hodgson N, Lovrics S, Lucibello K, Lovrics P. Relation between socioeconomic variables and surgical, systemic and radiation treatment in a cohort of patients with breast cancer in an urban Canadian centre. Can J Surg 2019; 62:83-92. [PMID: 30697993 DOI: 10.1503/cjs.009217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Studies have shown an association between socioeconomic status and breast cancer treatment. We examined the relation between socioeconomic status and the treatment of breast cancer (surgical, systemic and radiation) in a universal health care system. Methods Data from a single urban Canadian centre were collected for consecutive patients who received a diagnosis of breast cancer from January 2010 to December 2011. Variables included patient and disease factors, surgery type, systemic and radiation treatment, and breast reconstruction. Socioeconomic variables were obtained from 2006 Canadian census data. We used multivariable logistic regression to identify predictors of breast cancer treatment. Results A total of 721 patients were treated for breast cancer during the study period. Socioeconomic variables were not related to type of breast surgery for breast cancer. Age less than 50 years, having a first-degree relative with breast cancer and income status were predictors of breast reconstruction. Employment status was a consistent predictor of systemic and radiation treatment. Conclusion Employment consistently predicted systemic and radiation treatment, and age and income were predictors of breast reconstruction in a universal health care system. Further research is required to determine precisely how socioeconomic
factors affect care and to minimize possible disparities in delivery of health care services.
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Affiliation(s)
- Jennifer Li
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Sylvie D. Cornacchi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Forough Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Neil Johnston
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Shawn Forbes
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Susan Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Nicole Hodgson
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Sarah Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Kristen Lucibello
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Peter Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
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Silber JH, Rosenbaum PR, Ross RN, Reiter JG, Niknam BA, Hill AS, Bongiorno DM, Shah SA, Hochman LL, Even-Shoshan O, Fox KR. Disparities in Breast Cancer Survival by Socioeconomic Status Despite Medicare and Medicaid Insurance. Milbank Q 2019; 96:706-754. [PMID: 30537364 DOI: 10.1111/1468-0009.12355] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Policy Points Patients with low socioeconomic status (SES) experience poorer survival rates after diagnosis of breast cancer, even when enrolled in Medicare and Medicaid. Most of the difference in survival is due to more advanced cancer on presentation and the general poor health of lower SES patients, while only a very small fraction of the SES disparity is due to differences in cancer treatment. Even when comparing only low- versus not-low-SES whites (without confounding by race) the survival disparity between disparate white SES populations is very large and is associated with lower use of preventive care, despite having insurance. CONTEXT Disparities in breast cancer survival by socioeconomic status (SES) exist despite the "safety net" programs Medicare and Medicaid. What is less clear is the extent to which SES disparities affect various racial and ethnic groups and whether causes differ across populations. METHODS We conducted a tapered matching study comparing 1,890 low-SES (LSES) non-Hispanic white, 1,824 black, and 723 Hispanic white women to 60,307 not-low-SES (NLSES) non-Hispanic white women, all in Medicare and diagnosed with invasive breast cancer between 1992 and 2010 in 17 US Surveillance, Epidemiology, and End Results (SEER) regions. LSES Medicare patients were Medicaid dual-eligible and resided in neighborhoods with both high poverty and low education. NLSES Medicare patients had none of these factors. MEASUREMENTS 5-year and median survival. FINDINGS LSES non-Hispanic white patients were diagnosed with more stage IV disease (6.6% vs 3.6%; p < 0.0001), larger tumors (24.6 mm vs 20.2 mm; p < 0.0001), and more chronic diseases such as diabetes (37.8% vs 19.0%; p < 0.0001) than NLSES non-Hispanic white patients. Disparity in 5-year survival (NLSES - LSES) was 13.7% (p < 0.0001) when matched for age, year, and SEER site (a 42-month difference in median survival). Additionally, matching 55 presentation factors, including stage, reduced the disparity to 4.9% (p = 0.0012), but further matching on treatments yielded little further change in disparity: 4.6% (p = 0.0014). Survival disparities among LSES blacks and Hispanics, also versus NLSES whites, were significantly associated with presentation factors, though black patients also displayed disparities related to initial treatment. Before being diagnosed, all LSES populations used significantly less preventive care services than matched NLSES controls. CONCLUSIONS In Medicare, SES disparities in breast cancer survival were large (even among non-Hispanic whites) and predominantly related to differences of presentation characteristics at diagnosis rather than differences in treatment. Preventive care was less frequent in LSES patients, which may help explain disparities at presentation.
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Affiliation(s)
- Jeffrey H Silber
- Center for Outcomes Research, Children's Hospital of Philadelphia.,Leonard and Madlyn Abramson Cancer Center of the University of Pennsylvania.,University of Pennsylvania Perelman School of Medicine.,Division of Pediatric Oncology, Children's Hospital of Philadelphia.,The Wharton School, University of Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Paul R Rosenbaum
- The Wharton School, University of Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Richard N Ross
- Center for Outcomes Research, Children's Hospital of Philadelphia
| | - Joseph G Reiter
- Center for Outcomes Research, Children's Hospital of Philadelphia
| | - Bijan A Niknam
- Center for Outcomes Research, Children's Hospital of Philadelphia
| | - Alexander S Hill
- Center for Outcomes Research, Children's Hospital of Philadelphia
| | | | - Shivani A Shah
- Center for Outcomes Research, Children's Hospital of Philadelphia
| | - Lauren L Hochman
- Center for Outcomes Research, Children's Hospital of Philadelphia
| | - Orit Even-Shoshan
- Center for Outcomes Research, Children's Hospital of Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Kevin R Fox
- Leonard and Madlyn Abramson Cancer Center of the University of Pennsylvania.,University of Pennsylvania Perelman School of Medicine.,Hospital of the University of Pennsylvania
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Breast Cancer Incidence by Stage Before and After Change in Screening Guidelines. Am J Prev Med 2019; 56:100-108. [PMID: 30573138 PMCID: PMC6312406 DOI: 10.1016/j.amepre.2018.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The U.S. Preventive Services Task Force changed breast cancer screening guidelines in November 2009 for mammograms in women aged 40-49 and 50-74 years. The aim of this study was to assess the impact of the 2009 guideline changes on breast cancer incidence by stage among women aged 40-49 and 50-74 years in the U.S. METHODS This was a cross-sectional trend analysis of the impact of 2009 guideline change on breast cancer incidence by stage, using data from the National Program for Cancer Registries and Surveillance, Epidemiology, and End Results Incidence-U.S. Cancer Statistics 2001-2014 database among women aged 40-74 years. Incidence was age adjusted to the U.S. standard population. Data were collected in 2001-2014, released in 2017, and analyzed in 2018. RESULTS Among women aged 40-49 years, the 4-year average annual incidence of breast cancer increased slightly in 2011-2014 for in situ, localized, and distant cancer, but decreased for regional cancer compared with the incidence in 2006-2009. Among women aged 50-74 years, the 4-year average annual incidence of breast cancer increased in 2011-2014 for localized and distant cancer, but decreased for in situ and regional cancer. Joinpoint analyses revealed that annual percentage changes decreased after 2009 for distant cancer among both women aged 40-49 and 50-74 years. The composition of breast cancer by stage was similar between 2006-2009 and 2011-2014 among both women aged 40-49 and 50-74 years. CONCLUSIONS Changes in breast cancer screening by the 2009 U.S. Preventive Services Task Force guidelines had little immediate adverse effects on the stage distribution of breast cancer diagnoses in the U.S. Monitoring the incidence by cancer stages over time is needed.
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Neighborhoods and Breast Cancer Survival: The Case for an Archetype Approach. ENERGY BALANCE AND CANCER 2019. [DOI: 10.1007/978-3-030-18408-7_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Vang S, Margolies LR, Jandorf L. Mobile Mammography Participation Among Medically Underserved Women: A Systematic Review. Prev Chronic Dis 2018; 15:E140. [PMID: 30447104 PMCID: PMC6266518 DOI: 10.5888/pcd15.180291] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction Although breast cancer deaths have declined, the mortality rate among women from medically underserved communities is disproportionally high. Screening mammography is the most effective tool for detecting breast cancer in its early stages, yet many women from medically underserved communities do not have adequate access to screening mammograms. Mobile mammography may be able to bridge this gap by providing screening mammograms at no cost or low cost and delivering services to women in their own neighborhoods, thus eliminating cost and transportation barriers. The objective of this systematic review was to describe the scope and impact of mobile mammography programs in promoting mammographic screening participation among medically underserved women. Methods We searched electronic databases for English-language articles published in the United States from January 2010 through March 2018 by using the terms “mobile health unit,” “mammogram,” “mammography,” and “breast cancer screening.” Of the 93 articles initially identified, we screened 55; 16 were eligible to be assessed and 10 qualified for full text review and data extraction. Each study was coded for study purpose, research design, data collection, population targeted, location, sample size, outcomes, predictors, analytical methods, and findings. Results Of the 10 studies that qualified for review, 4 compared mobile mammography users with users of fixed units, and the other 6 characterized mobile mammography users only. All the mobile mammography units included reached underserved women. Most of the women screened in mobile units were African American or Latina, low income, and/or uninsured. Mobile mammography users reported low adherence to 1-year (12%–34%) and 2-year (40%–48%) screening guidelines. Some difficulties faced by mobile clinics were patient retention, patient follow-up of abnormal or inconclusive findings, and women inaccurately perceiving their breast cancer risk. Conclusion Mobile mammography clinics may be effective at reaching medically underserved women. Adding patient navigation to mobile mammography programs may promote attendance at mobile sites and increase follow-up adherence. Efforts to promote mammographic screening should target women from racial/ethnic minority groups, women from low-income households, and uninsured women. Future research is needed to understand how to best improve visits to mobile mammography clinics.
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Affiliation(s)
- Suzanne Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, Box 1077, New York, NY 10029.
| | - Laurie R Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, New York
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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46
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The main causes of death contributing to absolute and relative socio-economic inequality in Italy. Public Health 2018; 164:39-48. [DOI: 10.1016/j.puhe.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 11/19/2022]
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Breast Cancer Stage at Diagnosis in a New Jersey Cancer Education and Early Detection Site. Am J Clin Oncol 2018; 41:1043-1048. [DOI: 10.1097/coc.0000000000000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Breast Cancer Disparities Among Women in Underserved Communities in the USA. CURRENT BREAST CANCER REPORTS 2018; 10:131-141. [PMID: 31501690 DOI: 10.1007/s12609-018-0277-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review Breast cancer disparities that exist between high-income countries (HIC) and low- and middle-income countries (LMICs) are also reflected within population subgroups throughout the United States (US). Here we examine three case studies of US populations "left behind" in breast cancer outcomes/equity. Recent Findings African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State all experience a myriad of factors that contribute to lower rates of breast cancer detection and appropriate treatment as well as poorer survival. These factors, related to the social determinants of health, including geographic isolation, lack of availability of care, and personal constraints, can be addressed with interventions at multiple levels. Summary Although HICs have reduced mortality of breast cancer compared to LMICs, there remain inequities in the US healthcare system. Concerted efforts are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources.
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Mortality by occupation-based social class in Italy from 2012 to 2014. Int J Public Health 2018; 63:865-874. [PMID: 30051314 DOI: 10.1007/s00038-018-1149-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/26/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Evaluating socio-economic inequality in cause-specific mortality among the working population requires large cohort studies. Through this census-based study, we aimed to quantify disparities in mortality across occupation-based social classes in Italy. METHODS We conducted a historical cohort study on a sample of more than 16 million workers. We estimated the mortality rate ratios for each social class, considering upper non-manual workers as reference. RESULTS Non-skilled manual workers showed an increased mortality from upper aero-digestive tract, stomach and liver cancers, and from diseases of the circulatory system, transport accidents and suicides in both sexes, and from infectious diseases, diabetes, lung and bladder cancers only in men. Among women, an excess mortality emerged for cervical cancer, whereas mortality from breast and ovarian cancers was lower. When education was taken into account, the excess mortality decreased in men while was no longer significant in women. CONCLUSIONS There are remarkable disparities across occupation-based social classes in the Italian working population that favour the upper non-manual workers. Our data could be useful in planning policies for a more effective health and social security system.
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Kong AL, Nattinger AB, McGinley E, Pezzin LE. The relationship between patient and tumor characteristics, patterns of breast cancer care, and 5-year survival among elderly women with incident breast cancer. Breast Cancer Res Treat 2018; 171:477-488. [DOI: 10.1007/s10549-018-4837-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
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