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Padamsee TJ, Bijou C, Swinehart-Hord P, Hils M, Muraveva A, Meadows RJ, Shane-Carson K, Yee LD, Wills CE, Paskett ED. Risk-management decision-making data from a community-based sample of racially diverse women at high risk of breast cancer: rationale, methods, and sample characteristics of the Daughter Sister Mother Project survey. Breast Cancer Res 2024; 26:8. [PMID: 38212792 PMCID: PMC10785448 DOI: 10.1186/s13058-023-01753-x] [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: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND To understand the dynamics that limit use of risk-management options by women at high risk of breast cancer, there is a critical need for research that focuses on patient perspectives. Prior research has left important gaps: exclusion of high-risk women not in risk-related clinical care, exclusion of non-white populations, and lack of attention to the decision-making processes that underlie risk-management choices. Our objective was to create a more inclusive dataset to facilitate research to address disparities related to decision making for breast cancer risk management. METHODS The Daughter Sister Mother Project survey collects comprehensive information about the experiences of women at high risk of breast cancer. We collected novel measures of feelings about and reactions to cancer screenings; knowledge, barriers, and facilitators of risk-management options; beliefs related to cancer risk and risk management; and involvement with loved ones who had cancer. Eligible individuals were non-Hispanic white and non-Hispanic Black adult women who self-identified as having high risk of breast cancer and had no personal history of cancer. Between October 2018 and August 2019, 1053 respondents completed the online survey. Of these, 717 were confirmed through risk prediction modeling to have a lifetime breast cancer risk of ≥ 20%. Sociodemographic characteristics of this sample were compared to those of nationally representative samples of the US population: the 2019 Health Information National Trends Survey and the Pew Research Center report: Jewish Americans in 2020. RESULTS The sample of 717 women at objectively high risk of breast cancer was largely (95%) recruited from non-clinical sources. Of these respondents, only 31% had seen a genetic counselor, 34% had had genetic testing specific to breast cancer risk, and 35% had seen at least one breast or cancer care specialist. The sample includes 35% Black respondents and 8% with Ashkenazi Jewish ancestry. Although encompassing a substantial range of ages, incomes, and education levels, respondents are overall somewhat younger, higher-income, and more educated than the US population as a whole. CONCLUSIONS The DSM dataset offers comprehensive data from a community-based, diverse sample of women at high risk of breast cancer. The dataset includes substantial proportions of Black and Ashkenazi Jewish women and women who are not already in clinical care related to their breast cancer risk. This sample will facilitate future studies of risk-management behaviors among women who are and are not receiving high-risk care, and of variations in risk-management experiences across race and ethnicity.
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Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
| | - Christina Bijou
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Megan Hils
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Anna Muraveva
- Government Resources Center, The Ohio State University, Columbus, OH, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | | | - Lisa D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Celia E Wills
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
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Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center. J Racial Ethn Health Disparities 2022; 9:2323-2333. [PMID: 34647274 DOI: 10.1007/s40615-021-01169-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. METHODS Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. RESULTS African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. CONCLUSIONS We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.
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Babatunde OA, Eberth JM, Felder T, Moran R, Truman S, Hebert JR, Zhang J, Adams SA. Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women. J Racial Ethn Health Disparities 2021; 8:147-156. [PMID: 32385849 PMCID: PMC7648729 DOI: 10.1007/s40615-020-00766-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Mortality from breast cancer among Black women is 60% greater than that of White women in South Carolina (SC). The aim of this study was to assess racial differences in mortality among Black and White breast cancer patients based on variations in social determinants and access to state-based early detection programs. METHODS We obtained a retrospective record for breast cancer patients diagnosed between 2002 and 2010 from the SC Central Cancer Registry. Mortality was the main outcome while race-stratified Cox proportional hazard models were performed to assess disparities in mortality. We assessed effect modification, and we used an automated backward elimination process to obtain the best fitting models. RESULTS There were 3286 patients of which the majority were White women (2186, 66.52%). Compared with married White women, the adjusted hazard ratio (aHR) for mortality was greatest among Black unmarried women (aHR 2.31, CI 1.83, 2.91). Compared with White women who lived in the Low Country region mortality was greatest among Black women who lived in the Midland (aHR 2.17 CI 1.47, 3.21) and Upstate (aHR 2.96 CI 1.96, 2.49). Mortality was higher among Black women that were not receiving services in the Best Chance Network (BCN) program (aHR 1.70, CI 1.40, 2.04) compared with White women. CONCLUSIONS To reduce the racial disparity gap in survival in SC, Black breast cancer patients who live in the Upstate, are unmarried, and those that are not enrolled in the BCN program may benefit from more intense navigation efforts directed at early detection and linkage to breast cancer treatments.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.
| | - Jan M Eberth
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Tisha Felder
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - Robert Moran
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
- Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
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Ogunsina K, Naik G, Vin-Raviv N, Akinyemiju TF. Sequential matched analysis of racial disparities in breast cancer hospitalization outcomes among African American and White patients. Cancer Epidemiol 2017. [PMID: 28623836 DOI: 10.1016/j.canep.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The purpose of this study is to determine if racial disparities in inpatient outcomes persist among hospitalized patients comparing African American and White breast cancer patients matched on demographics, presentation and treatment. METHODS A total of 136,211 African American and White breast cancer patients from the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database, matched on demographics alone, demographics and presentation or demographics, presentation and treatment were studied. Conditional logistic regression was conducted to evaluate post-surgical complications, length of stay and in-hospital mortality outcomes. Analysis was further stratified by age (≤65 years and >65years) to evaluate whether disparities were larger in younger or older patients. All analysis was conducted using SAS 9.3. RESULTS White women had significantly shorter hospital length of stay when matched on demographics (β=-0.87, p-value=<0.0001), demographics and presentation (β=-0.63, p-value=<0.0001), and demographics, presentation and treatment (β=-0.51, p-value=<0.0001) compared with African Americans. White women also had lower odds of mortality compared with African American women when matched on demographics (OR: 0.72, 95% CI: 0.65-0.79), demographics and presentation (OR: 0.77, 95% CI: 0.71-0.85), or matched on demographics, presentation and treatment (OR: 0.80, 95% CI: 0.73-0.88). The racial difference observed in length of stay and mortality was larger in the age group ≤65 years compared with >65years CONCLUSION: African American women experienced higher odds of inpatient mortality and longer length of stay compared with White women even after accounting for differences in demographics, presentation and treatment characteristics.
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Affiliation(s)
- Kemi Ogunsina
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States
| | - Gurudatta Naik
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States; Comprehensive Cancer Center. University of Alabama at Birmingham, Birmingham AL, United States
| | - Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, CO, United States; School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, United States
| | - Tomi F Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States; Comprehensive Cancer Center. University of Alabama at Birmingham, Birmingham AL, United States.
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Vidal G, Bursac Z, Miranda-Carboni G, White-Means S, Starlard-Davenport A. Racial disparities in survival outcomes by breast tumor subtype among African American women in Memphis, Tennessee. Cancer Med 2017; 6:1776-1786. [PMID: 28612435 PMCID: PMC5504313 DOI: 10.1002/cam4.1117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/13/2017] [Accepted: 05/07/2017] [Indexed: 01/09/2023] Open
Abstract
Racial disparities in survival among African American (AA) women in the United States have been well documented. Breast cancer mortality rates among AA women is higher in Memphis, Tennessee as compared to 49 of the largest US cities. In this study, we investigated the extent to which racial/ethnic disparities in survival outcomes among Memphis women are attributed to differences in breast tumor subtype and treatment outcomes. A total of 3527 patients diagnosed with stage I-IV breast cancer between January 2002 and April 2015 at Methodist Health hospitals and West Cancer Center in Memphis, TN were included in the analysis. Kaplan-Meier survival curves were generated and Cox proportional hazards regression were used to compare survival outcomes among 1342 (38.0%) AA and 2185 (62.0%) non-Hispanic White breast cancer patients by race and breast tumor subtype. Over a mean follow-up time of 29.9 months, AA women displayed increased mortality risk [adjusted hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.35-2.03] and were more likely to be diagnosed at advanced stages of disease. AA women with triple-negative breast cancer (TNBC) had the highest death rate at 26.7% compared to non-Hispanic White women at 16.5%. AA women with TNBC and luminal B/HER2- breast tumors had the highest risk of mortality. Regardless of race, patients who did not have surgery had over five times higher risk of dying compared to those who had surgery. These findings provide additional evidence of the breast cancer disparity gap between AA and non-Hispanic White women and highlight the need for targeted interventions and policies to eliminate breast cancer disparities in AA populations, particularly in Memphis, TN.
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Affiliation(s)
- Gregory Vidal
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38133.,The University of Tennessee West Cancer Center, Germantown, Tennessee
| | - Zoran Bursac
- Division of Biostatistics and Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gustavo Miranda-Carboni
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, 38133
| | - Shelley White-Means
- Department of Clinical Pharmacy, Consortium on Health Education, Economic Empowerment and Research (CHEER), University of Tennessee Health Science Center, Memphis, Tennessee, 38163
| | - Athena Starlard-Davenport
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, Tennessee, 38133
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Connors SK, Goodman MS, Myckatyn T, Margenthaler J, Gehlert S. Breast reconstruction after mastectomy at a comprehensive cancer center. SPRINGERPLUS 2016; 5:955. [PMID: 27429869 PMCID: PMC4930439 DOI: 10.1186/s40064-016-2375-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 11/23/2022]
Abstract
Background Breast reconstruction after mastectomy is an integral part of breast cancer treatment that positively impacts quality of life in breast cancer survivors. Although breast reconstruction rates have increased over time, African American women remain less likely to receive breast reconstruction compared to Caucasian women. National Cancer Institute-designated Comprehensive Cancer Centers, specialized institutions with more standardized models of cancer treatment, report higher breast reconstruction rates than primary healthcare facilities. Whether breast reconstruction disparities are reduced for women treated at comprehensive cancer centers is unclear. The purpose of this study was to further investigate breast reconstruction rates and determinants at a comprehensive cancer center in St. Louis, Missouri. Methods Sociodemographic and clinical data were obtained for women who received mastectomy for definitive surgical treatment for breast cancer between 2000 and 2012. Logistic regression was used to identify factors associated with the receipt of breast reconstruction. Results We found a breast reconstruction rate of 54 % for the study sample. Women who were aged 55 and older, had public insurance, received unilateral mastectomy, and received adjuvant radiation therapy were significantly less likely to receive breast reconstruction. African American women were 30 % less likely to receive breast reconstruction than Caucasian women. Conclusion These findings suggest that racial disparities in breast reconstruction persist in comprehensive cancer centers. Future research should further delineate the determinants of breast reconstruction disparities across various types of healthcare institutions. Only then can we develop interventions to ensure all eligible women have access to breast reconstruction and the improved quality of life it affords breast cancer survivors.
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Affiliation(s)
- Shahnjayla K Connors
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO USA
| | - Terence Myckatyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO USA
| | - Julie Margenthaler
- Division of Endocrine Oncologic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO USA
| | - Sarah Gehlert
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO USA ; George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO USA
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Noel L, Connors SK, Goodman MS, Gehlert S. Improving breast cancer services for African-American women living in St. Louis. Breast Cancer Res Treat 2015; 154:5-12. [PMID: 26409834 PMCID: PMC4621693 DOI: 10.1007/s10549-015-3584-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality.
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Affiliation(s)
- Lailea Noel
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Shahnjayla K Connors
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Sarah Gehlert
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
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