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Survival and Surgery-to-Radiotherapy Intervals Among Asian American and Pacific Islander Women With Early Breast Cancer


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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.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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