Receipt Of Breast Cancer Treatment Research Articles

Abstract B008: South Carolina's National Breast and Cervical Cancer Early Detection Program narrows the gap in South Carolina breast cancer disparities

Abstract Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides screening for breast cancer and, ultimately, navigation to treatment services for women who are economically disadvantaged and unable to afford such services. Consequently, SC's NBCCEDP, the Best Chance Network (BCN), is crucial in helping to address the excess burden of breast cancer mortality experienced by black women as well as those with lower socio-economic status. Purpose: The purpose of this investigation was to compare time to each treatment modality (surgery, chemotherapy, radiation therapy, and hormonal therapy) between BCN participants and participants in Medicaid or a private payor insurance plan. Methods: SC Central Cancer Registry data (2002-2010) were linked to administrative data from Medicaid or another private payor insurance plan. Eligibility criteria included white or black race and continuous enrollment in their respective insurance plan for 3 years post diagnosis. Time from diagnosis to date of first surgery, chemotherapy, radiation therapy, and hormonal therapy were calculated from administrative data files. T-tests and chi-square tests were used to compare descriptive statistics as appropriate. Cox proportional hazards models were used to assess the relationship among BCN participation, treatment times, and survival. Results: No significant differences were noted for time to surgery, chemotherapy, or hormonal therapy between BCN participants and the rest of the cohort. Interestingly, significant differences were noted between the two groups for time to radiation therapy (178 days for BCN vs. 150 days for the rest of the cohort, p=0.05). In multivariable Cox models, there were no breast cancer survival differences by BCN participation (p=0.94) after adjusting for age, stage, and insurance type. Among BCN participants, Cox models did not demonstrate any relationship between treatment time (for any treatment type) or race with survival after adjusting for age and stage. Conclusion: This work provides evidence that emphasizes the important role that state programs such as the BCN play in navigating women into timely treatment and eliminating the disparity that is often seen for the receipt of breast cancer treatment among economically disadvantaged women. Furthermore, this work highlights the potential for these programs to decrease mortality disparities experienced by black women in SC. Citation Format: Swann Arp Adams, Samantha C. Truman, Oluwole Babatunde, Tisha M. Felder, Jan M. Eberth, Sue P. Heiney, Christian R. Alvarado, James R. Hebert. South Carolina's National Breast and Cervical Cancer Early Detection Program narrows the gap in South Carolina breast cancer disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B008.

Abstract P6-10-03: The association between type-2 diabetes and risk of mortality after invasive breast cancer among Hispanic and non-Hispanic white women from New Mexico

Abstract Background: Evidence suggests that the presence of Type-2 diabetes at the time of breast cancer diagnosis adversely affects survival independent of breast cancer stage, grade, and tumor phenotype. Few of these epidemiological studies have included Hispanic breast cancer survivors in whom diabetes and obesity are prevalent. Objective: We examined the association between self-reported diabetes history, breast cancer-specific and all-cause mortality among Hispanic and non-Hispanic white (NHW) women diagnosed with breast cancer (stages I-IIIa) from the New Mexico Health, Eating, Activity, and Lifestyle cohort. Methods: A total of 399 breast cancer survivors (96 Hispanic, 303 NHW) contributed data for the present study. Women with breast cancer diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) registry in New Mexico. Baseline demographic characteristics and breast cancer risk factors were collected approximately 5 months post diagnosis by trained interviewers. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using multivariable Cox proportional hazards regression models. Models were further stratified by ethnicity. Results: After a median follow-up time of 13.5 years from baseline interview to death, a total of 134 deaths occurred. The prevalence of diabetes did not significantly differ by ethnicity in our study; 11.5% of Hispanics reported having diabetes compared to 7.5% of NHW women. While a history of diabetes was associated with older age at breast cancer diagnosis (p=0.001), higher percent body fat (p=0.01), higher body mass index (p< 0.001), and increased waist-hip ratio (p< 0.001) compared to non-diabetics, no significant differences were observed between diabetics and non-diabetics for breast cancer stage, grade, tumor phenotype, or receipt of breast cancer treatment. In multivariable models, diabetes was associated with increased risk of all-cause mortality overall (HR, 2.10; 95% CI 1.24-3.55), with a significant association only observed among Hispanic women (HR, 3.07; 95% CI 1.05-8.94) when compared to NHW women (HR, 1.66; 95% CI 0.86-3.24). The interaction between ethnicity and diabetes was not statistically significant for all-cause mortality. Diabetes also was significantly associated with increased risk of breast cancer-specific mortality (HR, 2.89; 95% CI 1.27-6.60); however results were not statistically significant by ethnicity. Conclusions: Overall, diabetes significantly increased risk of all-cause mortality among women diagnosed with invasive BC from our study, particularly among Hispanic women. Diabetes was also found to be a significant prognostic factor for breast-cancer specific mortality. Future studies utilizing this data will be conducted to further evaluate the association between diabetes, glycemic control and breast cancer-specific mortality in Hispanic and NHW women. Citation Format: Connor AE, Visvanathan K, Boone SD, Baumgartner KB, Baumgartner RN. The association between type-2 diabetes and risk of mortality after invasive breast cancer among Hispanic and non-Hispanic white women from New Mexico [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-03.

Breast Cancer Treatment and Survival Among Department of Defense Beneficiaries: An Analysis by Benefit Type and Care Source.

Use of treatment for breast cancer is dependent on the patient's cancer characteristics and willingness to undergo treatment and provider treatment recommendations. Receipt of breast cancer treatment varies by insurance status and type. It is not clear whether different benefit types and care sources differ in breast cancer treatment and outcomes among Department of Defense beneficiaries. The objectives of this study are to assess whether receipt of breast cancer treatment varied by benefit type (TRICARE Prime vs non-Prime) or care source (direct care, purchased care, and both) and to examine whether survival and recurrence differed by benefit type and/or care source among female Department of Defense beneficiaries with the disease. Study subjects were women aged 40-64 yr, diagnosed with malignant breast cancer between 2003 and 2007. Multivariable logistic regression analyses were conducted to assess the likelihood of receiving treatment by benefit type or care source. Multivariable Cox proportional hazard models were used to investigate differences in survival and recurrence by benefit type or care source. A total of 2,668 women were included in this study. Those with Prime were more likely to have chemotherapy, radiation, hormone therapy, breast-conserving surgery, surveillance mammography, and recurrence than women with non-Prime. Survival was high, with 94.86% of those with Prime and 92.58% with non-Prime alive at the end of the study period. Women aged 50-59 yr with non-Prime benefit type had better survival than women with Prime of the same age. No survival differences were seen by care source. In regard to recurrence, women aged 60-64 yr with TRICARE Prime were more likely to have recurrent breast cancer than women with non-Prime. Additionally, women aged 50-59 yr who used purchased care were less likely to have a recurrence than women who used direct care only. To our knowledge, this is the first study to examine breast cancer treatment and survival by care source and benefit type in the Military Health System. In this equal access health care system, no differences in treatment, except mastectomy, by benefit type, were observed. There were no overall differences in survival, although patients with non-Prime tended to have better survival in the age group of 50-59 yr. In regard to care source, women who utilized mostly purchased care or utilized both direct and purchased care were more likely to receive certain types of treatment, such as chemotherapy and radiation, as compared with women who used direct care only. However, survival did not differ between different care sources. Future research is warranted to further investigate variations in breast cancer treatment and its survival gains by benefit type and care source among Department of Defense beneficiaries.

Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California.

Clinical guidelines recommend breast-conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans are more likely than other groups to have mastectomy or omit radiation after BCS. We applied polytomous logistic regression and recursive partitioning to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California Asian Americans diagnosed with stage 0 to II breast cancer from 1990 to 2007. The percentage receiving mastectomy ranged from 40% among U.S.-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some Asian Americans ethnicities, and additional factors including hospital [smaller hospital size, not National Cancer Institute cancer center, low socioeconomic status (SES) patient composition, and high hospital Asian Americans patient composition] and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through recursive partitioning, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity. Tumor characteristics and, secondarily, patient, hospital, and neighborhood factors are predictors of mastectomy and omission of radiation following BCS among Asian Americans. By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options.

Racial/ethnic differences in treatment delay in a multiethnic sample of women with breast cancer

6503 Background: Factors contributing to racial/ethnic variation in breast cancer treatment delay remain understudied, especially in multi-ethnic population-based samples. Methods: 3,252 women with non-metastatic breast cancer diagnosed between 6/05–2/07 and reported to the Los Angeles County and Detroit, Surveillance Epidemiologic and End Results (SEER) registries were surveyed after initial treatment (mean time from diagnosis = 8.9 months). Latina and African American (AA) women were over- sampled (n=2260, eligible response rate 72.1%). Treatment delay was defined as the patient's report of the duration between when breast cancer was first diagnosed and first surgical procedure (< 1month, 1–3months, ≥4 months) . Multinomial logistic regression models were used to estimate the relative odds of treatment delay by race/ethnicity before and after adjustment for sociodemographics (age, education, income, marital status), clinical factors (number of co-morbidities, health status at diagnosis), and access barriers (difficulty: finding doctors to treat cancer, scheduling surgical procedure, getting to doctor's office). Results: Of the 2195 women who had a surgical procedure, 6.9 % experienced treatment delay of ≥4 months (10.4% Latina, 9.3% AA, 5.5% white women). Latina and AA women were more likely to experience longer treatment delay than white women [OR for ≥4 months/1–3 months vs. < 1 month: 2.18/1.77 for Latinas; 1.78/1.50 for AA (p<.001)] (Table). Racial/ethnic differences persisted after adjustment for sociodemographic, clinical factors, and access barriers [OR for ≥4 months/1–3 months vs. < 1 month: 1.31/1.79 for Latinas; 1.64/1.55 for AA, (p<.001)] (Table), although Latina vs. white differences were no longer statistically significant. Conclusions: Our results confirm that racial/ethnic minorities are vulnerable to delay in receipt of breast cancer treatment in a large population based sample of breast cancer patients. Further work is needed to evaluate the underlying causes of this delay. [Table: see text] No significant financial relationships to disclose.