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- Title
Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA.
- Authors
Gaba, Anu G.; Cao, Li; Renfrew, Rebecca J.; Witte, DeAnn; Wernisch, Janet M.; Sahmoun, Abe E.; Goel, Sanjay; Egland, Kristi A.; Crosby, Ross D.
- Abstract
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.
- Subjects
UNITED States; BREAST cancer prognosis; BREAST tumor diagnosis; ALASKA Natives; RESEARCH funding; T-test (Statistics); MULTIPLE regression analysis; HEALTH insurance; WHITE people; CHI-squared test; MULTIVARIATE analysis; DESCRIPTIVE statistics; LONGITUDINAL method; KAPLAN-Meier estimator; ODDS ratio; CONFIDENCE intervals; SOCIODEMOGRAPHIC factors; NATIVE Americans; PROPORTIONAL hazards models; COMORBIDITY
- Publication
Journal of Racial & Ethnic Health Disparities, 2024, Vol 11, Issue 4, p2378
- ISSN
2197-3792
- Publication type
Article
- DOI
10.1007/s40615-023-01704-4