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Lubarsky M, Hernandez AE, Collie BL, Westrick AC, Thompson C, Kesmodel SB, Goel N. Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment? Breast Cancer Res Treat 2024; 206:509-517. [PMID: 38809304 DOI: 10.1007/s10549-024-07245-6] [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: 05/31/2023] [Accepted: 01/03/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment. METHODS We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment. RESULTS 5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR)Model1 0.58 (0.45-0.74); ORModel2 0.59 (0.46-0.78); ORModel3 0.62 (0.47-0.81); ORModel4 0.53 (0.40-0.69); ORModel5 0.59(0.46-0.76); p < 0.05]. CONCLUSION To our knowledge, this is the first analysis assessing receipt of NCCN guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation.
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Affiliation(s)
- Maya Lubarsky
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexandra E Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Brianna L Collie
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Ashly C Westrick
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cheyenne Thompson
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
| | - Susan B Kesmodel
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL, USA.
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA.
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
- Division of Surgical Oncology | Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street | Suite 410, Miami, FL, 33136, USA.
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Chen JC, Handley D, Elsaid MI, Fisher JL, Owusu-Brackett N, Azap L, Bhattacharyya O, Pawlik TM, Carson WE, Obeng-Gyasi S. Racial disparities in disease-specific mortality and surgical management of patients with ductal carcinoma in situ with microinvasion. J Surg Oncol 2024; 129:1179-1186. [PMID: 38643486 DOI: 10.1002/jso.27625] [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: 01/04/2024] [Revised: 02/23/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Given persistent racial disparities in breast cancer outcomes, this study explores racial differences in disease-specific mortality and surgical management among patients with microinvasive ductal carcinoma in situ (DCIS-MI). METHODS The Surveillance, Epidemiology, and End Results Program was queried for patients aged 18+ years with DCIS-MI between January 1, 2010 and December 31, 2018. The study cohort was divided into non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients. Disease-specific mortality was evaluated using Cox proportional hazards models. RESULTS A total of 3400 patients were identified, of which 569 (16.7%) were NHB and 2831 (83.3%) were NHW. Compared with NHW patients, NHB patients had more positive lymph nodes (7.6% vs. 3.9% p < 0.001). In addition, NHB women were more likely to undergo axillary lymph node dissection (6.0% vs. 3.8%, p = 0.044) and receive chemotherapy (11.8% vs. 7.2%, p < 0.001). There were no racial differences in breast surgery type (p = 0.168), reconstructive surgery (p = 0.362), or radiation therapy (p = 0.342). Overall, NHB patients had worse disease-specific mortality (adjusted hazard ratio 2.13, 95% confidence interval [CI]: 1.10-4.14) with mortality risks diverging from NHW women after 3 years (6 years rate ratio [RR] 2.12, 95% CI: 1.13-4.34; 9 years RR 2.32, 95% CI: 1.24-4.35). CONCLUSIONS NHB women with DCIS-MI present with higher nodal disease burden and experience worse disease-specific mortality than NHW women.
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Affiliation(s)
- J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, USA
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, USA
| | - James L Fisher
- The Ohio State University College of Medicine, Columbus, Ohio, USA
- James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Nicci Owusu-Brackett
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA
| | - Lovette Azap
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Oindrila Bhattacharyya
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
- The William Tierney Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, Indiana, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, Ohio, USA
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Hernandez AE, Mahal B, Telonis AG, Figueroa M, Goel N. Response to: Comment on Genetic Ancestry-Specific Molecular and Survival Differences in Admixed Breast Cancer Patients. ANNALS OF SURGERY OPEN 2024; 5:e424. [PMID: 38911651 PMCID: PMC11191929 DOI: 10.1097/as9.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 06/25/2024] Open
Affiliation(s)
- Alexandra E. Hernandez
- From the Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Brandon Mahal
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - Aristeidis G. Telonis
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL
| | - Maria Figueroa
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Neha Goel
- From the Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Hernandez AE, Goel N. ASO Author Reflections: Translational Epidemiology in Breast Cancer Research: Integrating Social and Biological Data to Understand Disparities. Ann Surg Oncol 2024; 31:1656-1657. [PMID: 38071718 DOI: 10.1245/s10434-023-14661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Alexandra E Hernandez
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- Harvard T.H. Chan School of Public Health and Dana-Farber Cancer Institute, Boston, MA, USA.
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