In a National Cancer Database analysis reported in JCO Oncology Practice, Champion et al identified patterns in disease characteristics, time to surgery, and overall survival among Hispanic patients of different races and among Hispanic and non-Hispanic women of the same race.
Study Details
The study involved data from the National Cancer Database on women who had been diagnosed with stage 0 to IV breast cancer and had undergone lumpectomy or mastectomy between 2004 and 2014. Tumor subtype and stage at diagnosis were compared by race/ethnicity.
“Hispanic women had improved overall survival vs non-Hispanic women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.”— Champion et al
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Analysis for time to surgery was adjusted for year of diagnosis, distance traveled for treatment, Charlson-Deyo comorbidity score, education, income, insurance status, facility type, facility location, clinical TNM classifications, grade, histology, estrogen receptor/progesterone receptor status, and surgery.
Analysis for overall survival was adjusted for year of diagnosis; distance traveled for treatment; Charlson-Deyo comorbidity score; education; income; insurance status; facility type; facility location; clinical TNM classifications; grade; histology; estrogen receptor/progesterone receptor status; surgery type; and receipt of chemotherapy, endocrine therapy, and radiation.
Key Findings
The analysis involved a total of 44,374 Hispanic women, of whom 79 (0.2%) were American Indian, 1,011 (2.3%) Black, 41,126 (92.7%) White, and 2,158 (4.9%) of another race; and 858,634 non-Hispanic women, of whom 2,319 (0.3%) were American Indian, 97,206 (11.3%) Black, 727,270 (84.7%) White, and 31,839 (3.7%) other.
Hispanic Black women had lower rates of triple-negative disease (16.2%) vs non-Hispanic Black women (23.5%) but higher rates vs Hispanic White women (13.9%; overall P < .001).
Hispanic White women had higher rates of node-positive disease (23.2%) vs non-Hispanic White women (14.4%) but lower rates than Hispanic Black (24.6%) and non-Hispanic Black women (24.5%; overall P < .001).
Hispanic White women had longer time to surgery vs non-Hispanic White women (unadjusted median = 46 days vs 33 days). The difference was observed irrespective of treatment sequence: adjusted means were 42.7 vs 38.6 days among those receiving adjuvant chemotherapy (P < .001) and 208.5 vs 201.1 days among those receiving neoadjuvant chemotherapy (P < .001). No significant racial differences in time to surgery were observed among Hispanic patients.
After adjustment, Hispanic White women (hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.74–0.81) and Hispanic Black women (HR = 0.75, 95% CI = 0.58–0.96) had improved overall survival vs non-Hispanic White women (reference group) and non-Hispanic Black women (HR = 1.15, 95% CI = 1.12–1.18). For all comparisons, the P value was < .05.
The investigators concluded, “Hispanic women had improved overall survival vs non-Hispanic women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.”
Oluwadamilola M. Fayanju, MD, MA, MPHS, of Duke University Medical Center, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by grants from the National Institutes of Health. For full disclosures of the study authors, visit ascopubs.org.
