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Racial disparities in curative intent surgery, endocrine therapy, and treatment-related adverse effects were seen among women with breast cancer in a recent single-center study.

Breast cancer (BC) is the most common malignancy occurring worldwide among women. Racial disparities in BC outcomes and access to treatment are well documented, but there’s a lack of evidence regarding BC treatment patterns and treatment-related adverse events. 

A study in Scientific Reports conducted a race-stratified analysis of differences in BC treatment patterns and treatment adverse effects in non-Hispanic women.

Study Population

A total of 17,454 non-Hispanic women with BC were included. The median age was 63 years. Most participants were non-Hispanic White (NHW; 82%), while 18% were non-Hispanic Black (NHB). The NHW and NHB participants were followed up for a median of 8.1 and 4.4 years, respectively. NHBs had a significantly lower median age at diagnosis and a significantly higher probability of prior smoking history, proportion of ductal carcinoma, stage IV disease, and Charlson comorbidity scores ≥5 than NHWs.

Disparities in Breast Cancer Treatment Patterns 

Comparison of treatment rates in NHBs vs. NHWs showed that NHB women had significantly higher rates of surgery (58% vs. 50.1%, p<0.001), radiotherapy (42.1% vs. 28%, p<0.001), chemotherapy (34.6% vs. 24.6%, p<0.001), hormone therapy (42.6% vs. 40.9%), immunotherapy (4.1% vs. 2.8%, p<0.001), and combined therapy. 

Analysis of specific medications revealed that NHBs were prescribed both anthracycline-containing and non-anthracycline-containing regimens at significantly higher rates than NHWs. NHBs were also prescribed endocrine therapies at significantly higher rates than NHWs: aromatase inhibitors (p<0.001), LHRH agonists (p=0.01), ER antagonists (p<0.001), as well as other biologic therapies (p<0.001).

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Differences in Cancer Treatment Delays and Appointments for NHBs

Contrarily, NHBs had longer delays for surgery (median of 42 vs. 34 days), radiotherapy (median of 204 vs. 138 days), chemotherapy (median of 70 vs. 62 days), and time to initiation of endocrine therapy (median of 138 vs. 126 days). NHBs had lower median appointment completion rates despite a higher number of appointments per patient.

Higher Rates of Chemotherapy-Related Complications Observed in Non-Hispanic Black Patients

NHBs demonstrated higher rates of chemotherapy-related complications (20.9% vs. 12.2%, p<0.001) than NHWs, including cardiomyopathy, diarrhea/enteritis, fatigue, nausea/vomiting, dehydration/hypovolemia, neuropathy, rash, lung disease, pain, and infusion reactions, along with higher reported rates of cognitive decline/dementia (13.6% vs. 6.7%, p<0.001). NHBs also showed higher rates of cardiotoxicity, acute myocardial infarction (p=0.01), and pneumonitis (p=0.003); however, no differences in the incidence of overall immune-related toxicities were seen.

Differential Breast Cancer Treatment and Mental Health Outcomes in Non-Hispanic Blacks

Multivariable regression analysis revealed that compared to NHWs, NHBs had a lower probability of undergoing curative intent surgery for BC (adjusted hazard ratio: 0.92) and of being prescribed endocrine therapy (aHR: 0.83) but a higher probability of receiving adjuvant radiotherapy (aHR: 1.40). Regarding treatment-related adverse mental health effects, NHBs had a higher risk of cognitive decline/dementia (aHR: 1.30) and a lower probability of being diagnosed with psychological issues (aHR: 0.71).

Source

Stabellini, N., Cullen, J., Cao, L., Shanahan, J., Hamerschlak, N., Waite, K., Barnholtz‐Sloan, J. S., & Montero, A. J. (2023). Racial disparities in breast cancer treatment patterns and treatment related adverse events. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-27578-4 

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