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Koric A, Chang CPE, Lee YCA, Wei M, Lee CJ, Tao R, Wang J, Tay D, Hashibe M. Incident diabetes among older Asian, Native Hawaiian, and Pacific Islander women with breast cancer. JNCI Cancer Spectr 2024; 8:pkae051. [PMID: 38924519 PMCID: PMC11253921 DOI: 10.1093/jncics/pkae051] [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: 01/23/2024] [Revised: 05/20/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The risk of diabetes among Asian, Native Hawaiian, and Pacific Islander (ANHPI) women after breast cancer is unclear. This study estimated the risk of incident type II diabetes in older ANHPI and older non-Hispanic White (NHW) women with breast cancer from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Medicare linked claims. METHODS A matched cohort of 7122 older ANHPI and 21 365 older NHW women with breast cancer were identified from SEER-Medicare between 2000 and 2017. To assess the risk of incident type II diabetes after breast cancer, hazard ratios (HRs) and 95% confidence intervals (95% CI) were estimated using the Cox proportional-hazards regression model. RESULTS During the mean 8 years of follow-up, 9.3% of older women with breast cancer developed incident type II diabetes. In comparison with older NHW women, older ANHPI women without a known history of diabetes had an elevated risk of diabetes after breast cancer, with strong associations observed for Pacific Islander (HR = 3.09, 95% CI = 1.43 to 6.67), Vietnamese (HR = 2.12, 95% CI = 1.33 to 2.36), and Filipino (HR = 2.02, 95% CI = 1.57 to 2.59) women with breast cancer, adjusting for potential confounders. Among ANHPI women with breast cancer, more baseline comorbidities and obesity were risk factors for developing incident type II diabetes. CONCLUSION ANHPI women diagnosed with breast cancer had an elevated risk of type II diabetes compared with older NHW women with breast cancer. Routine monitoring and management of diabetes are warranted in older ANHPI women with breast cancer.
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Affiliation(s)
- Alzina Koric
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Chun-Pin Esther Chang
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Yuan-Chin Amy Lee
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mei Wei
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Oncology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Catherine J Lee
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Hematology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Randa Tao
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jing Wang
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Eden CM, Syrnioti G, Johnson J, Fasano G, Bayard S, Alston C, Liu A, Zhou XK, Ju T, Newman LA, Malik M. Breast Cancer Incidence Among Asian American Women in New York City: Disparities in Screening and Presentation. Ann Surg Oncol 2024; 31:1455-1467. [PMID: 38055093 DOI: 10.1245/s10434-023-14640-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Asian American (AsAm) women have some of the lowest rates of up-to-date breast cancer screening, and lack of disaggregated racial/ethnic data can mask disparities. We evaluated presentation patterns among AsAms at two hospitals with distinct communities: New York Presbyterian-Queens (NYPQ), in Flushing, Queens and Weill Cornell Medical Center (WCM), on the Upper East Side (UES) neighborhood of Manhattan. PATIENTS AND METHODS Patients with newly diagnosed breast cancer between January 2019 and December 2022 were identified using a prospective database and clinical data collected. Patients were categorized as self-reported Asian versus Non-Asian. The Asian group was disaggregated as Chinese-Asian versus Other-Asian. Physician workforce data were obtained from public records. RESULTS A total of 3546 patients (1162 NYPQ, 2384 WCM) were included. More NYPQ patients identified as Asian compared with WCM (49 vs. 14%, p < 0.001). Asian patients were mostly East Asian Chinese (NYPQ 61%, WCM 53%). More Chinese patients at NYPQ reported Chinese as their preferred language (81 vs. 33%, p < 0.001). Greatest differences of screen-detected disease frequency were seen between NYPQ and WCM Chinese patients (75 vs. 59%, p < 0.001). Eighty percent of NYPQ Chinese patients presented with stage 0/I disease versus 69% at WCM (p = 0.007), a difference not observed between Other-Asian patients (75% NYPQ, 68% WCM, p = 0.095). 3% of UES physicians versus 16% in Flushing reported speaking Chinese. CONCLUSIONS Chinese patients residing in a neighborhood with more Chinese-speaking physicians more frequently presented with screen-detected, early-stage breast cancer. Stage distribution differences were not apparent among the aggregated pool of Other-Asian patients, suggesting cancer disparities may be masked when ethnic groups are studied in aggregate.
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Affiliation(s)
- Claire M Eden
- Department of Surgery, New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Georgia Syrnioti
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Josh Johnson
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Genevieve Fasano
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Solange Bayard
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Chase Alston
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Anni Liu
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Xi Kathy Zhou
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Tammy Ju
- Department of Surgery, New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Lisa A Newman
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Manmeet Malik
- Department of Surgery, New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA.
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Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [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: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Knoedler S, Kauke-Navarro M, Knoedler L, Friedrich S, Matar DY, Diatta F, Mookerjee VG, Ayyala H, Wu M, Kim BS, Machens HG, Pomahac B, Orgill DP, Broer PN, Panayi AC. Racial disparities in surgical outcomes after mastectomy in 223 000 female breast cancer patients: a retrospective cohort study. Int J Surg 2024; 110:684-699. [PMID: 38052017 PMCID: PMC10871660 DOI: 10.1097/js9.0000000000000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Breast cancer mortality and treatment differ across racial groups. It remains unclear whether such disparities are also reflected in perioperative outcomes of breast cancer patients undergoing mastectomy. STUDY DESIGN The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2021) to identify female patients who underwent mastectomy for oncological purposes. The outcomes were stratified by five racial groups (white, Black/African American, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) and included 30-day mortality, reoperation, readmission, surgical and medical complications, and non-home discharge. RESULTS The study population included 222 947 patients, 68% ( n =151 522) of whom were white, 11% ( n =23 987) Black/African American, 5% ( n =11 217) Asian, 0.5% ( n =1198) American Indian/Alaska Native, and 0.5% ( n =1018) Native Hawaiian/Pacific Islander. While 136 690 (61%) patients underwent partial mastectomy, 54 490 (24%) and 31 767 (14%) women received simple and radical mastectomy, respectively. Overall, adverse events occurred in 17 222 (7.7%) patients, the largest portion of which were surgical complications ( n =7246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications [odds ratio (OR)=0.71; P <0.001], whereas American Indian/Alaska Native women were most vulnerable to the complication occurrence (OR=1.41; P <0.001). Black/African American patients had a significantly lower risk of medical (OR=0.59; P <0.001) and surgical complications (OR=0.60; P <0.001) after partial and radical mastectomy, respectively, their likelihood of readmission (OR=1.14; P =0.045) following partial mastectomy was significantly increased. CONCLUSION The authors identified American Indian/Alaska Native women as particularly vulnerable to complications following mastectomy. Asian patients experienced the lowest rate of complications in the perioperative period. The authors' analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Their findings call for care equalization in the field of breast cancer surgery.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Leonard Knoedler
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Friedrich
- Department of Mathematical Statistics and Artificial Intelligence in Medicine, University of Augsburg, Augsburg, Germany
| | - Dany Y. Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fortunay Diatta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Vikram G. Mookerjee
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Haripriya Ayyala
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Guenther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - P. Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Fane LS, Wei AH, Tripathi R, Bordeaux JS. Asian American and Pacific Islander patients with melanoma have increased odds of treatment delays: A cross-sectional study. J Am Acad Dermatol 2023; 89:529-536. [PMID: 37224968 DOI: 10.1016/j.jaad.2023.05.028] [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: 02/21/2023] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Asian American and Pacific Islander (AAPI) melanoma patients have higher mortality than non-Hispanic White (NHW) patients. Treatment delays may contribute, but whether AAPI patients have longer time from diagnosis to definitive surgery (TTDS) is unknown. OBJECTIVES Investigate TTDS differences between AAPI and NHW melanoma patients. METHODS Retrospective review of AAPI and NHW melanoma patients in the National Cancer Database (NCD) (2004-2020). The association of race with TTDS was evaluated by multivariable logistic regression, controlling for sociodemographic characteristics. RESULTS Of 354,943 AAPI and NHW melanoma patients identified, 1155 (0.33%) were AAPI. AAPI patients had longer TTDS for stage I, II, and III melanoma (P < .05 for all). Adjusting for sociodemographic factors, AAPI patients had 1.5 times the odds of a TTDS between 61 and 90 days and twice the odds of a TTDS >90 days. Racial differences in TTDS persisted in Medicare and private insurance types. Uninsured AAPI patients had the longest TTDS (mean, 53.26 days), while those with private insurance had the shortest TTDS (mean, 34.92 days; P < .001 for both). LIMITATION AAPI patients comprised 0.33% of the sample. CONCLUSIONS AAPI melanoma patients have increased odds of treatment delays. Associated socioeconomic differences should inform efforts to reduce disparities in treatment and survival.
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Affiliation(s)
- Lauren S Fane
- School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Angela H Wei
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Raghav Tripathi
- Department of Dermatology, Johns Hopkins, Baltimore, Maryland
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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