Sociodemographic and clinicopathologic factors of triple negative breast cancer at an academic urban safety-net hospital.

Abstract

1090 Background: Racial disparities in breast cancer in the United States is a persistent and ongoing problem. Decades of research is derived from large population based data sets and little is published with granular detail of specific, actionable factors to target for interventions. From a large urban safety-net hospital, we evaluate sociodemographic and clinicopathologic factors on survival outcomes of triple negative breast cancer. Methods: We conducted a single-institution retrospective study of patients with invasive breast cancer, diagnosed and treated between January 2010 and December 2021 at an academic safety-net hospital where insurance systems allow for access and treatment for all patients. Demographic, tumor and treatment characteristics were obtained. Chi-square and ANOVA were used to examine associated factors among White, Black, and other races. Survival was analyzed using the Kaplan-Meier estimator and log-rank test. Significant risk factors were identified with Cox regression analysis. Results: 251 women with invasive triple negative breast cancer were diagnosed and treated during the study period. Median age was 58 years, 68.9% were non-white, and 64.9% were publicly insured or uninsured patients. Median time from diagnosis to treatment initiation was 29 days and follow up period was 1392 days. Having a non-English primary language and living in areas with lower socioeconomic indices are observed in non-White patients (P=0.003, 0.033) and predictive of a higher clinical stage at presentation (P=0.011, 0.021). Black patients were diagnosed at higher histologic grade (Black: 82.4%, White: 79.7%; P=0.003) and White patients were more likely to change facility during the treatment course (White: 32.4%, Black: 16.03%; P=0.005). No significant racial disparities were observed in time to treatment, recurrence rate, and overall survival. Among patients indicated for adjuvant therapies, including chemotherapy, immunotherapy, and radiation, rates of recommendation and completion of therapy did not vary by race. Five year survival did not significantly vary by race when adjusted for demographic and clinicopathologic factors. Conclusions: At an academic urban safety-net hospital where access to diagnostic and treatment resources are comparable across patient populations, no racial disparities were seen in treatment, recurrence, and survival outcomes. Further research on racial differences in breast cancer biology and health behaviors may improve understanding of triple negative disease or mitigate later stage diagnosis.