Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women

Abstract

Background Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. Methods Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010–2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. Results From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. Conclusion This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.

Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction

“…This finding should be interpreted with caution owing to small numbers but is noteworthy considering that little is known regarding outcome disparities in this group. Prior research has shown that those who identify as American Indian/ Alaska Native experience considerable health disparities 29,30 and, specific to breast cancer, are more likely than White patients to present for treatment with advanced-stage breast cancer 31 and less likely to undergo breast-conserving surgery. 32 Future work is needed to understand the barriers to quality cancer care experienced by Indigenous people to develop mitigation strategies.…”

Trends in Alzheimer Disease Mortality Among American Indian and Alaska Native People Between 2011 and 2019

“…These areas contain or are located adjacent to federally recognized tribal lands 20. Approximately 62% of the AI/AN people live in PRCDA counties and race classification for AI/AN people is more accurate in these areas compared with other counties 21 Figure 1. shows the location of PRCDA counties in the United States.…”

Healthcare segregation in orthopedic surgery: A statewide analysis of American Indian and Alaska Native patients

“…American Indian and Alaska Native (AIAN) patients face significant healthcare disparities when seeking and receiving care from numerous surgical subspecialties, including bariatric, vascular, and oncologic surgery 1–3 . Furthermore, AIAN populations remain the most impoverished racial group in the United States, with centuries of structural racism and longitudinal psychological trauma contributing to higher rates of mental illness and substance use alongside a life expectancy 5.5 years shorter than the US average 4 .…”