Abstract P5-14-10: Examining inequities associated with incarceration among patients with breast cancer

Abstract

Background: As of 2020, approximately 2.3 million people were incarcerated in federal and state prisons across the United States (US). Both the total number of individuals experiencing incarceration and the average age of this population have been increasing steadily, raising concerns over the criminal legal system’s capacity to ensure adequate healthcare for this aging and expanding population. People who experience incarceration carry a heavy burden of disease and are more likely to belong to racial and ethnic minority groups. Despite known risk factors, little data exist with regards to treatment patterns and quality of care for breast cancer among these individuals. We sought to examine disease and treatment characteristics among individuals diagnosed with and treated for breast cancer during an episode of incarceration. Methods: We derived our analytic population from patients ≥14 years old who received a breast-cancer diagnosis at the University of North Carolina Hospitals (a tertiary care center) between 4/14/2014 and 12/30/2020. Patient demographics including incarceration status during diagnosis, disease characteristics, and treatment details were summarized with N (%) for categorical variables and median (interquartile range, IQR) for continuous variables. Comparisons were made according to incarceration exposure: never incarcerated (NI) vs diagnosis before incarceration (BI) vs diagnosis during time of incarceration (DI). Differences were tested using the chi-square or Fisher’s exact test for categorical variables and Wilcoxon rank sum or Kruskal-Wallis test for continuous variables. Linear regression was used to estimate the association of incarceration status with time to treatment, modeled separately by treatment sequence (neoadjuvant or upfront surgery). Results: Of the 4332 patients with analyzable data, 34 (0.8%) were either actively incarcerated at time of diagnosis (DI n=24, 70.6%) or were diagnosed before incarceration (BI n=10, 29.4%). Compared to those who were NI or BI, DI patients were more likely to be single (%, DI (50%) vs NI (16.8%) vs BI (10%), p<0.001), more likely to be using illicit drugs at time of diagnosis (%, DI (12.5%) vs NI (1.9%) vs BI (0%), p=0.01), and more likely to have a family history of breast cancer (%, DI (66.7%) vs NI (41.5%) vs BI (30%), p=0.03). There were no differences between DI, NI, and BI patients with regards to race/ethnicity, tumor receptors, or clinical or pathological stage at diagnosis. However, DI patients were less likely to receive neoadjuvant therapy than those who were NI or BI (%, DI (0%) vs NI (8.2%) vs BI (20%), p=0.01). Among patients who received upfront surgery, being incarcerated at time of diagnosis was associated with a time-to-treatment that was 23.4 days longer than that of patients who were never incarcerated (95% CI, 9.5-37.3 days, p=0.001). Conclusion: None of the individuals who were diagnosed with breast cancer during incarceration received neoadjuvant treatment. Among all women who received surgery as their first treatment, diagnosis during incarceration was associated with longer time-to-surgery compared to those never incarcerated. These findings are concerning for missed treatment opportunities within the carceral system. Further research is necessary to understand the full scope of disparities and the systemic factors that contribute to them. Citation Format: Oluwadamilola Motunrayo Fayanju, Yoshiko Iwai, Alice YunziL Yu, Samantha M Thomas, Andrea K Knittel, Kelly E Westbrook. Examining inequities associated with incarceration among patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-10.