In a study reported in JCO Oncology Practice, Taparra et al identified differences in 10-year survival and surgery-to-radiotherapy intervals among disaggregated Asian American and Native Hawaiian/other Pacific Islander women with early-stage breast cancer.
The study used National Cancer Database data on 578,927 women diagnosed with stage 0 to II breast cancer between 2004 and 2017. Of these, 559,784 were non-Hispanic White women (reference group). The disaggregated Asian American and Native Hawaiian/other Pacific Islander group consisted of 8,004 East Asian; 3,650 South Asian; 5,928 Southeast Asian; and 1,561 Native Hawaiian/other Pacific Islander women. The rationale for the study was the premise that the customary aggregation of these groups masks significant health disparities.
Key Findings
In the entire cohort, 10-year overall survival was 83%, reflecting the 10-year rate of 83% in White women. The rate among combined Asian American and Native Hawaiian/other Pacific Islander women was 91%; disaggregated rates were 92% for East Asian, 90% for South Asian, 90% for Southeast Asian, and 83% for Native Hawaiian/other Pacific Islander women. On multivariate analysis, compared with white women, Native Hawaiian/other Pacific Islander women had worse survival (adjusted hazard ratio [aHR] = 1.38, 95% confidence interval [CI] = 1.09–1.77), and East Asian (aHR = 0.57, 95% CI = 0.48–0.69), South Asian (aHR = 0.66, 95% CI = 0.51–0.84), and Southeast Asian women (aHR = 0.78, 95% CI = 0.65–0.94) had improved survival.
In the entire cohort, the median surgery-to-radiotherapy interval was 64 days, reflecting the median of 64 days among White women. The median surgery-to-radiotherapy interval among combined Asian American and Native Hawaiian/other Pacific Islander women was 73 days; disaggregated intervals were 68 days for East Asian, 80 days for South Asian, 77 days for Southeast Asian, and 81 days for Native Hawaiian/other Pacific Islander women.
On adjusted analysis, compared with White women, Southeast Asian and Native Hawaiian/other Pacific Islander women had significantly longer median surgery-to-radiotherapy intervals, by 6.6 days (95% CI = 4.3–8.9 days) and 10.0 days (95% CI = 5.8–14 days), respectively. Median interval was increased by 1.1 days (95% CI = –1.7 to 3.8 days) among South Asian and 0.49 days (95% CI = –1.5 to 2.5 days) among East Asian women. Among women who received adjuvant chemotherapy followed by radiotherapy, the median surgery-to-radiotherapy interval compared with White women was longer among East Asian (by 4.1 days), South Asian (by 3.8 days), Southeast Asian (by 6.4 days), and Native Hawaiian/other Pacific Islander women (by 13 days).
The investigators concluded, “Breast cancer disparities exist among disaggregated Asian American and Native Hawaiian/other Pacific Islander subpopulations. Data disaggregation insights may lead to interventions to overcome these disparities, such as optimizing time-to-treatment for select populations.”
Kekoa Taparra, MD, PhD, of the Department of Radiation Oncology, Stanford University School of Medicine, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was funded by a grant from the National Cancer Institute and a Conquer Cancer Foundation Merit Award. For full disclosures of the study authors, visit ascopubs.org.
