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Disparities in Primary Breast Cancer Stage at Presentation Among Hispanic Subgroups

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups.

Methods

Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status.

Results

Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18–1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51–1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease.

Conclusion

Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.

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Funding

Brandon A. Mahal is funded by the Prostate Cancer Foundation (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center. Idalid Franco is funded in part through a Diversity Supplement from the Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health. Edward Christopher Dee, Kaitlyn Lapen, and Fumiko Chino are funded in part through NIH/NCI Support Grant P30 CA008748.

Author information

Authors and Affiliations

  1. University of Massachusetts Chan Medical School, Worcester, MA, USA

    Nishwant Swami MPH

  2. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Nishwant Swami MPH

  3. University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Tiffany Nguyen MD

  4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Edward Christopher Dee MD, Kaitlyn Lapen MD & Fumiko Chino MD

  5. Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA

    Idalid Franco MD, MPH

  6. Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA

    Yefri A. Baez MD

  7. Harvard Medical School, Boston, MA, USA

    Yefri A. Baez MD

  8. Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Lora Wang MD & Brandon A. Mahal MD

  9. Department of Surgical Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Neha Goel MD

  10. Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD

  11. Rena Rowan Breast Center, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD

  12. Penn Center for Cancer Care Innovation, The University of Pennsylvania, Philadelphia, PA, USA

    Oluwadamilola M. Fayanju MD

  13. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Narjust Duma MD

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  1. Nishwant Swami MPH
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Contributions

Nishwant Swami, Edward Christopher Dee, and Fumiko Chino had full access to all the data and had final responsibility for the decision to submit this article for publication. Concept and Design: All authors. Acquisition, analysis, and interpretation of data: All authors. Drafting of the manuscript: Nishwant Swami, Tiffany Nguyen, and Edward Christopher Dee. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Nishwant Swami and Edward Christopher Dee.

Corresponding author

Correspondence to Fumiko Chino MD.

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Disclosures

Narjust Duma has provided consulting/advisory services for Pfizer, Merck, BMS, AstraZeneca, Genentech, Neogenomics, Janssen, BI Oncology, and Inivata. Nishwant Swami, Tiffany Nguyen, Edward Christopher Dee, Idalid Franco, Yefri A. Baez, Kaitlyn Lapen, Lora Wang, Neha Goel, Brandon A. Mahal, Oluwadamilola M. Fayanju, and Fumiko Chino have no conflicts of interest to declare relevant to this submission.

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Swami, N., Nguyen, T., Dee, E.C. et al. Disparities in Primary Breast Cancer Stage at Presentation Among Hispanic Subgroups. Ann Surg Oncol 29, 7977–7987 (2022). https://doi.org/10.1245/s10434-022-12302-9

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  • DOI: https://doi.org/10.1245/s10434-022-12302-9

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