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Socioeconomic and Surgical Disparities are Associated with Rapid Relapse in Patients with Triple-Negative Breast Cancer

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A subset of triple-negative breast cancer (TNBC) is characterized by aggressive disease, rapid relapse, and mortality within 24 months of diagnosis, termed “rapid relapse” TNBC (rrTNBC). The objective of this study is to define the association between sociodemographic variables and surgical management among rrTNBC patients in the Surveillance, Epidemiology and End Results (SEER) Program.

Methods

TNBC patients diagnosed from January 1, 2010 to December 31, 2014 with local or regional disease were identified in SEER. Patients were stratified as rrTNBC, defined as disease specific mortality ≤ 24 months after diagnosis, and non-rrTNBC. Chi-squared tests, t tests, and multivariable logistic regression were used to assess the association of rapid relapse with sociodemographic variables and surgical management.

Results

The cohort included 8% (1378/17,369) rrTNBCs. A higher proportion of rrTNBC patients had no surgery (11.7%) compared with non-rrTNBC (2.6%). Omission of axillary staging among patients who had surgery was 6.2% rrTNBC versus 4.5% non-rrTNBC. Black race (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05–1.43; p = 0.01; white ref), Medicaid or no insurance (Medicaid OR 1.53, 95% CI 1.31–1.79; p < 0.001; no insurance OR 1.74, 95% CI 1.31–2.32; p < 0.001; private ref), single status (OR 1.19, 95% CI 1.01–1.39; p = 0.03; married ref), no breast (OR 2.35, 95% CI 1.77–3.11; p < 0.001; mastectomy ref), and no axillary surgery (OR 1.44, 95% CI 1.13–1.83; p = 0.003 axillary surgery ref) were associated with rapid relapse.

Conclusions

Medicaid or no insurance, single status, black race, and no surgery are associated with higher odds of rrTNBC in SEER. These results indicate an interplay between socioeconomic factors, clinical and genomic variables may be disproportionately contributing to worse outcomes among a subset of TNBC patients.

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Author notes

  1. Samilia Obeng-Gyasi and Daniel G. Stover have jointly directed the work.

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA

    Samilia Obeng-Gyasi MD, MPH

  2. The Ohio State University College of Medicine, Columbus, OH, USA

    Samilia Obeng-Gyasi MD, MPH, Sarah Asad MPH, James L. Fisher PhD & Daniel G. Stover MD

  3. Stefanie Spielman Comprehensive Breast Center, Columbus, OH, USA

    Samilia Obeng-Gyasi MD, MPH & Daniel G. Stover MD

  4. James Cancer Hospital and Solove Research Institute, Columbus, OH, USA

    James L. Fisher PhD & Daniel G. Stover MD

  5. Department of Biomedical Informatics, Lincoln Tower, The Ohio State University, Columbus, OH, USA

    Saurabh Rahurkar BDS, DrPH

  6. Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Daniel G. Stover MD

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Obeng-Gyasi, S., Asad, S., Fisher, J.L. et al. Socioeconomic and Surgical Disparities are Associated with Rapid Relapse in Patients with Triple-Negative Breast Cancer. Ann Surg Oncol 28, 6500–6509 (2021). https://doi.org/10.1245/s10434-021-09688-3

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