Impact of socioeconomic status and rurality on cancer-specific survival among women with de novo metastatic breast cancer by race/ethnicity

Huang, Hsiao‐Ching; Smart, Morton; Zolekar, Ashwini; Deng, Huiwen; Hubbard, Colin; Hoskins, Kent; Ko, Naomi; Guadamuz, Jenny S.; Calip, Gregory S.

doi:10.1007/s10549-022-06603-6

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…There was no correlation between HER2‐low status and patient identifying as Black (OR = 0.97, 95% CI 0.83–1.13). This is consistent with previous research, with one 2022 study of 33,976 metastatic breast cancer patients finding Black women had the greatest (89%) five‐year cumulative incidence of cancer‐specific death compared to women of other racial identifications 15 . However, a 2015 multivariable analysis of risk factors among 4364 patients with metastatic breast cancer found patients identifying as Black had poorer survival for HER2‐positive but not HER2‐negative tumors.…”

Section: Discussionsupporting

confidence: 88%

“…A 2022 study of 33,976 women with metastatic breast cancer found that Hispanic women were more likely to be HER2-negative than HER2-positive (31% vs. 28%, p < 0.01); this study did not differentiate between HER2-low and fully HER2-negative cancers. 15 Hormone receptor-positive cancers are known to have improved survival among metastatic breast cancer patients. 2 Our binomial analysis found patients with ER-positive tumors were more likely to be HER2low (OR = 2.13 95% CI 1.99-2.30).…”

Section: Populationmentioning

confidence: 99%

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Prognostic implications of HER2NEU‐low in metastatic breast cancer

Neubauer,

Hasan,

Press

et al. 2024

Cancer Medicine

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IntroductionWe explored characteristics and clinical outcomes of HER2‐negative and HER2‐low metastatic breast cancers using real‐world data.MethodsWe queried the National Cancer Database to identify MBC patients that were HER2‐low or HER2‐negative per immunohistochemical staining. A binomial regression analysis identified demographic and clinical correlates of each subtype. A Cox multivariable regression analysis (MVA) and propensity‐match analysis were performed to identify correlates of survival.ResultsExcluding missing data, 24,636 MBC patients diagnosed between 2008 and 2015 were identified; 27.9% were HER2‐negative and 72.1% were HER2‐low. There were no relevant demographic differences between the groups. HER2‐low tumors were half as likely to have concomitant hormone receptor‐positive status (p < 0.01). The 3‐year survival rate among hormone receptor‐negative patients was 33.8% for HER2‐low and 32.2% for HER2‐negative (p < 0.05), and 60.9% and 55.6% in HER2‐low and HER2‐negative cases among hormone receptor‐positive patients (p < 0.05), respectively. HER2‐low cases were associated with better survival on MVA (HR =0.95, 95% CI 0.91–0.99) and remained superior with propensity‐matching (HR = 0.92, 95% CI 0.89–0.96). In a subset analysis isolated to hormone receptor‐positive cases, HER2‐low remained correlated with improved survival (HR = 0.93, 95% CI 0.89–0.98) with propensity‐matched MVA. Correlates of worse survival include older age as a continuous variable (HR = 1.02, 95% CI 1.02–1.02) and Black race (HR = 1.26, 95% CI 1.20–1.32) [all p < 0.01].ConclusionsIn the largest such analysis performed to date, our study demonstrates a small but statistically significant association with improved survival for HER2‐low tumors compared to HER2‐negative tumors in MBC.

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Section: Discussionsupporting

confidence: 88%

Section: Populationmentioning

confidence: 99%

Prognostic implications of HER2NEU‐low in metastatic breast cancer

Neubauer,

Hasan,

Press

et al. 2024

Cancer Medicine

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“…Similarly, patients undergoing endovascular cardiac procedures who were residents of rural areas had higher rates of vascular complications, bleeding, and mortality [ 135 ]. In general, rural areas have been found to exhibit health disparities compared with urban areas [ 136 – 139 ], and more research concerning disparities in the management and outcomes of PAD in rural populations is needed.…”

Section: Resultsmentioning

confidence: 99%

Disparities in peripheral artery disease care: A review and call for action

Demsas

Joiner

Telma

et al. 2022

Seminars in Vascular Surgery

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“…Compared to NHW women, NHB and Hispanics experienced increased (sHR 1.15, 95%CI 1.11-1.19) and similar risk (sHR 1.03, 95% CI 0.99-1.07) of breast cancer-speci c mortality, respectively. Among women with HR + MBC, residing in areas with the lowest SES quintile was associated with an increased risk of BC mortality among NHW (sHR 1.19, 95%CI 1.12-1.26), Black (sHR 1.21, 95%CI 1.05-1.39), and Hispanic (sHR 1.18, 95%CI 1.02-1.37) women [31]. These results suggest that socioeconomic factors affect the risk of breast cancer death in patients with MBC.…”

Section: Discussionmentioning

confidence: 98%

Racial disparities in overall survival after the introduction of cyclin-dependent kinase 4/6 inhibitors for patients with hormone receptor-positive, HER2-negative metastatic breast cancer

Alvarez

Bernal

Anampa

2022

Breast Cancer Res Treat

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Purpose: CDK4/6i combined with endocrine therapy have improved HR+/HER2-metastatic breast cancer (MBC) outcomes. However, it is still unclear whether the response to CDK4/6i is similar for all races. Therefore, we aimed to assess overall survival (OS) trends strati ed by race in patients with HR+/HER2-MBC after the approval of CDK4/6i, as part of the standard of care, in 2015.Methods: We performed a population-based study using the SEER database. Patients with HR+/HER2-MBC were divided into two time-based cohorts: 1) 2011-2013, corresponding to the pre-CDK4/6i era, and 2) 2015-2017 to the post-CDK4/6i era. We used propensity score matching and identi ed 2,684 patients in each cohort that matched in several characteristics. Kaplan-Meier curves and Cox proportional hazard models were used to estimate 2-year OS.Additionally, we compared survival between groups with a strati ed log-rank test. Lastly, we compared OS and breast cancer death risk between cohorts (strati ed by race) using Fine and Gray model. Results:The 2-year OS rate was 65% for the post-CDK4/6i group and 62% for the pre-CDK4/6i cohort (strati ed logrank p=0.025). The 2-year OS for NHW patients improved in the post-CDK4/6i era compared to the pre-CDK4/6i era (67% vs. 63%, p=0.033). However, OS did not improve for NHB (54% vs. 54%, p=0.876) or Hispanic (67% vs 65%, p=0.617) groups.Conclusions: Our study con rms that outcomes for HR+/HER2-MBC have improved after CDK4/6i were introduced in 2015. However, this effect is primarily driven by the improved OS in NHW patients, without signi cant improvement in OS in NHB or Hispanics.

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Impact of socioeconomic status and rurality on cancer-specific survival among women with de novo metastatic breast cancer by race/ethnicity

Cited by 12 publications

References 23 publications

Prognostic implications of HER2NEU‐low in metastatic breast cancer

Prognostic implications of HER2NEU‐low in metastatic breast cancer

Disparities in peripheral artery disease care: A review and call for action

Racial disparities in overall survival after the introduction of cyclin-dependent kinase 4/6 inhibitors for patients with hormone receptor-positive, HER2-negative metastatic breast cancer

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