In a single-institution study reported in JAMA Oncology, Eckhert et al found that patients with breast cancer from sex and gender minority groups experienced delayed diagnosis and had a shorter time to cancer recurrence compared to cisgender heterosexual patients.
Study Details
In the retrospective, case-control study, 92 patients from sex and gender minority groups treated at Stanford University School of Medicine from January 2008 to January 2022 were matched with 92 cisgender heterosexual patients for year of diagnosis, age, tumor stage, estrogen receptor (ER) status, and HER2 status. Among the 92 sex and gender minority group patients, 74 identified as lesbian, 12 identified as bisexual, and 6 identified as transgender men. Median age at diagnosis among all patients was 49 years (interquartile range [IQR] = 43–56 years).
Key Findings
On multivariate analysis adjusting for race and ethnicity, socioeconomic status, and private insurance status, patients from sex and gender minority groups were significantly more likely than cisgender heterosexual patients to:
- Have a delay in time from symptom onset to diagnosis (median time to diagnosis = 64 days [IQR = 32–118 days], vs 34 days [IQR = 16–75 days]; adjusted hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.42–0.99, P = .04)
- Decline an oncologist-recommended treatment modality (38% vs 20%, adjusted odds ratio = 2.27, 95% CI = 1.09–4.74, P = .03)
- Experience breast cancer recurrence (32.2% vs 13.3%, adjusted HR = 3.07, 95% CI = 1.56–6.03, P = .001).
On multivariate analysis, no significant differences between groups were observed for missing guideline-based screening; appropriate referral for genetic testing; mastectomy; chest reconstruction; adjuvant radiation therapy after lumpectomy; neoadjuvant chemotherapy for stage III disease; antiestrogen therapy for at least 5 years for ER-positive disease; HER2-targeted therapy for HER2-positive disease; or time from diagnosis to treatment.
The investigators concluded, “This study found that among patients with breast cancer, those from sex and gender minority groups experienced delayed diagnosis, and faster recurrence at a 3-fold higher rate compared with cisgender heterosexual patients. These results suggest disparities in the care of patients from sex and gender minority groups and warrant further study to inform interventions.”
Erik Eckhert, MD, MS, of the Department of Medicine, Stanford University School of Medicine, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Breast Cancer Research Foundation, Susan and Richard Levy Gift Fund, Suzanne Pride Bryan Fund for Breast Cancer Research, Regents of the University of California’s California Breast Cancer Research Program, and others. For full disclosures of the study authors, visit jamanetwork.com.
