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Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women
Authors:María Elena Martínez  Scarlett L Gomez  Li Tao  Rosemary Cress  Danielle Rodriguez  Jonathan Unkart  Richard Schwab  Jesse N Nodora  Linda Cook  Ian Komenaka  Christopher Li
Institution:1.Moores Cancer Center, University of California, San Diego,La Jolla,USA;2.Department of Family Medicine and Public Health,University of California, San Diego,La Jolla,USA;3.Cancer Prevention Institute of California,Fremont,USA;4.Stanford Cancer Institute,Palo Alto,USA;5.California Cancer Registry, Public Health Institute,Sacramento,USA;6.Department of Surgery,University of California, San Diego,La Jolla,USA;7.Department of Internal Medicine,University of New Mexico and the University of New Mexico Comprehensive Cancer Center,Albuquerque,USA;8.Maricopa Medical Center, Department of Surgery,Phoenix,USA;9.Division of Public Health Sciences,Fred Hutchinson Cancer Research Center,Seattle,USA
Abstract:

Purpose

To assess tumor subtype distribution and the relative contribution of clinical and sociodemographic factors on breast cancer survival between Hispanic and non-Hispanic whites (NHWs).

Methods

We analyzed data from the California Cancer Registry, which included 29,626 Hispanic and 99,862 NHW female invasive breast cancer cases diagnosed from 2004 to 2014. Logistic regression was used to assess ethnic differences in tumor subtype, and Cox proportional hazard modeling to assess differences in breast cancer survival.

Results

Hispanics compared to NHWs had higher odds of having triple-negative (OR = 1.29; 95% CI 1.23–1.35) and HER2-overexpressing tumors (OR = 1.19; 95% CI 1.14–1.25 HR?] and OR = 1.39; 95% CI 1.31–1.48 HR+]). In adjusted models, Hispanic women had a higher risk of breast cancer mortality than NHW women (mortality rate ratio MRR] = 1.24; 95% CI 1.19–1.28). Clinical factors accounted for most of the mortality difference (MRR = 1.05; 95% CI 1.01–1.09); however, neighborhood socioeconomic status (SES) and health insurance together accounted for all of the mortality difference (MRR = 1.01; 95% CI 0.97–1.05).

Conclusions

Addressing SES disparities, including increasing access to health care, may be critical to overcoming poorer breast cancer outcomes in Hispanics.
Keywords:
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