Abstract P5-12-06: Adolescent and young adult breast cancer in Texas: Risk factors for delayed diagnosis, including distance to clinical trials

Abstract

Background:Breast cancer is the most commonly diagnosed cancer among adolescent and young (AYA) adult females, ages 15-39. Approximately 14% of all AYA cancers diagnosed in females are breast cancer. AYAs represent 7% of all female breast cancer diagnoses. AYAs diagnosed with breast cancer have larger proportions of cancers with lower estrogen receptor positivity and over expression of HER2, triple negative subtypes, and cancers associated with familial history. These factors suggest the need for increased surveillance of young women diagnosed with breast cancer and strong consideration for their enrollment into clinical trials. Objective: To analyze geographic and socioeconomic factors that may increase risk and disparities in access to clinical trials for Texas AYA breast cancer survivors. Research Questions; 1) What are the factors, including access to clinical trials, that affect Texas AYA breast cancer patients being diagnosed at later versus earlier stages? 2) What are the associations between various demographic and diagnostic risk factors and AYAs breast cancer survivors’ distance to clinical trials? Data Sources, Population and Methods: Data sources include SEER 18 and Texas Limited Use data bases for incidence analyses. Data on breast cancer clinical trials was provided by www.BreastCancerTrials.org. Texas AYA breast cancer population data for 4153 women diagnosed from 2005 to 2009, was provided by the Texas Cancer Registry under IRB protocol 13-022. Methods for this study included use of SEER Stat for incidence analysis, ESRI ArcGIS 10.1 mapping and ESRI GIS Network Analysis tools to determine individual patient locations and distance to trials. Stata statistical software (12.1) was used to for bivariate and logistic regression modeling and analyses. Selected Results: 1) In a comparison of U.S. SEER 18 and Texas Limited Use data, for the overall female AYA breast cancer populations and for nearly all of the racial and ethnic subgroups, Texas' age adjusted incidence rates for this age group (15-39) are higher than the U.S. incidence rates. 2) With insured patients as the reference, uninsured self pay patients were 70% (p-value< 0.000, CI 1.31, 2.20) more likely to be diagnosed at later stages; 3) Being of Hispanic/Latina ethnicity was associated with at 36% greater risk of late stage diagnosis (p-value <0.000, CI 1.16,1.59) 4) Black African American AYAs were 31% more likely to be diagnosed at a later stage (p-value 0.004, CI 1.08,1.58) 5) Using <45 miles distance to clinical trials as a reference, AYA breast cancer patients living 45-100 miles from an appropriate trial were 102% more likely to be diagnosed at later stages (p-value< 0.000, CI 1.65,2.48) 6) AYA patients living furthest from trials, over 200 miles, were 49% more likely to be diagnosed at later versus earlier stages of breast cancer (p-value 0.020, CI 1.06, 2.09). Discussion: This is the first study to consider geographic, demographic and diagnostic factors, including distance to appropriate trials, in exploring early versus late staging of breast cancer among AYAs. The findings and discussion of results have both practice and policy implications related to access to care and clinical trials for AYA breast cancer survivors. Citation Format: Deborah Vollmer Dahlke, Ellyn Cohen. Adolescent and young adult breast cancer in Texas: Risk factors for delayed diagnosis, including distance to clinical trials [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-12-06.