Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA.

Autor: Gaba AG; Sanford Roger Maris Cancer Center, Department of Medicine, University of North Dakota, 820 4th Street N, Fargo, ND, 58102, USA. Anu.gaba@sanfordhealth.org., Cao L; Sanford Center for Biobehavioral Research, Fargo, ND, USA., Renfrew RJ; Sanford Health, Fargo, ND, USA., Witte D; Eli Lilly, Indianapolis, USA., Wernisch JM; Sanford Health, Sioux Falls, SD, USA., Sahmoun AE; University of North Dakota, Grand Forks, ND, USA., Goel S; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Egland KA; SAB Biotherapeutics, Inc, Sioux Falls, SD, USA., Crosby RD; Sanford Center for Biobehavioral Research, Fargo, ND, USA.
Jazyk: angličtina
Zdroj: Journal of racial and ethnic health disparities [J Racial Ethn Health Disparities] 2024 Aug; Vol. 11 (4), pp. 2378-2389. Date of Electronic Publication: 2023 Jul 11.
DOI: 10.1007/s40615-023-01704-4
Abstrakt: Importance: Breast cancer (BC) death rates have not improved for American Indian/Alaska Native (AI/AN) women, whereas, it has significantly decreased for non-Hispanic White (White) women.
Objective: Delineate the differences in patient and tumor characteristics among AI/AN and Whites with BC, and its impact on age and stage at diagnosis as well as overall survival (OS).
Methods: Hospital-based, cohort study using the National Cancer Database to identify female AI/AN and Whites diagnosed with BC between the years 2004 and 2016.
Results: BC in 6866 AI/AN (0.3%) and 1,987,324 Whites (99.7%) were studied. The median age at diagnosis was 58 for AI/AN and 62 for Whites. AI BC patients traveled double the distance for treatment, lived in lower median income zip codes, had a higher percentage of uninsured, higher comorbidities, lower percentage of Stage 0/I, larger tumor size, greater number of positive lymph nodes, higher proportion of triple negative and HER2-positive BC than Whites. All the above comparisons were significant, p<0.001. Association between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AI/AN and Whites. Unadjusted OS was worse for AI/AN as compared to Whites (HR=1.07, 95% CI=1.01-1.14, p=0.023). After adjustment of all covariates, OS was not different (HR=1.038, 95%CI=0.902-1.195, p=0.601).
Conclusion: There were significant differences in patient/tumor characteristics among AI/AN and White BC which adversely impacted OS in AI/AN. However, when adjusted for various covariates, the survival was similar, suggesting that the worse survival in AI/AN is mostly the impact of known biological, socio-economic, and environmental determinants of health.
(© 2023. W. Montague Cobb-NMA Health Institute.)
Databáze: MEDLINE
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