Abstract 1836: Racial/ethnic disparities in breast cancer diagnosis and prognosis

Abstract

Abstract Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death in American women. While incidence rates are declining, socioeconomic factors, access to care, and genetic predisposition contribute to disparities in breast cancer diagnosis, treatment, and survival in minority and underserved populations. Compared to Non-Hispanic White (NHW), African-American (AA) and Hispanic White (HW) women have lower breast cancer incidence rates; however, AA and HW women suffer a higher percentage of early age, advance-stage diagnosis, more aggressive tumor phenotype, and poorer stage-specific survival. The causes for these disparities are poorly understood. We evaluated tumor registry data (2000-2008) of Sylvester Comprehensive Cancer Center and a county-based Jackson Memorial Hospital, which serves the medically underserved population in South Florida. The final data included 950 NHW, 1137 non-Cuban HW, 809 Cuban HW, and 892 AA breast cancer cases. The results showed that a higher proportion of AA breast cancer cases (13%) suffers younger age of diagnosis (<40) compared to NHW (9%). There was a significantly (p<0.001) higher proportion of AA (33%) diagnosed with late-stage (III-IV) breast cancer compared to that in NHW (20%). In addition, our breast cancer patients have a 2-fold higher late-stage diagnosis (20% NHW and 33% AA) compared to the NCI SEER database (10% NHW and 18% AA). The ER/PR status was available since 2004. A larger proportion of AA patients (39%) have the double ER/PR negative tumor phenotype compared to that in NHW (22%) or HW (25%) breast cancer cases. With a median follow up of 48 months, our data showed that early-stage (I and II) Cuban HW and AA cases have a 1.57- (95%CI=1.11-2.24)and 2.09-fold (95%CI=1.48-2.95) worse clinical outcome compared to NHW women. Late-stage (III and IV) AA breast cancer cases have a 2.20-fold (95%CI=1.41-3.43) worse clinical outcome compared to NHW. This difference may be attributed to disparities in tumor biology and access/response to treatment. Intriguingly, Cuban HW women in our patient population have similar tumor characteristics compared to NHW in terms of age and stage of diagnosis and ER/PR status; however, they suffered worse stage-specific clinical outcome (recurrent or persistent disease) compared to NHW. This disparity in clinical outcome will need to be evaluated regarding factors that impact clinical outcome (e.g., physical activity, smoking, dietary fat, etc) with long-term follow-up studies. In summary, we demonstrated that underserved or minority breast cancer patients suffer worse breast cancer diagnosis and prognosis; future clinic- and community-based research studies are warranted to improve early detection and clinical outcome in understudied populations with worse breast cancer diagnosis and prognosis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1836.