Racial and Ethnic Disparity in Symptomatic Breast Cancer Awareness despite a Recent Screen: The Role of Tumor Biology and Mammography Facility Characteristics

Abstract

BACKGROUND In a racially and ethnically diverse sample of recently diagnosed urban breast cancer patients, we examined associations of patient, tumor biology and mammography facility characteristics on the probability of symptomatic discovery of their breast cancer despite a recent prior screening mammogram. METHODS In the Breast Cancer Care in Chicago study, self-reports at interview were used to define patients as having a screen-detected breast cancer or having symptomatic awareness despite a recent screening mammogram (SADRS), in the past one or two years. Patients with symptomatic breast cancer who did not report a recent prior screen were excluded from these analyses. Characteristics associated with more aggressive disease (estrogen and progesterone receptor negative status and higher tumor grade) were abstracted from medical records. Mammogram facility characteristics that might indicate aspects of screening quality were defined and controlled for in some analyses. RESULTS SADRS was more common among nH Black and Hispanic than nH White patients (36% and 42% vs. 25%, respectively, p=0.0004). SADRS was associated with ER/PR negative and higher grade disease. Patients screened at sites that relied on dedicated radiologists, and sites that were breast imaging centers of excellence were less likely to report SADRS. Tumor and facility factors together accounted for two-thirds of the disparity in SADRS (proportion mediated=70%, p=0.02). CONCLUSION Facility resources and tumor aggressiveness explain much of the racial/ethnic disparity in symptomatic breast cancer among recently screened patients. IMPACT: A more equitable distribution of high quality screening would ameliorate but not eliminate this disparity.

Atypical Chemokine Receptor 1 (DARC/ACKR1) in Breast Tumors Is Associated with Survival, Circulating Chemokines, Tumor-Infiltrating Immune Cells, and African Ancestry

“…4-8; i.e., triple-negative basal-like) in women of west African descent (9)(10)(11)(12). Overall, women of African descent are more likely to be diagnosed with the worst types of breast cancer, including triple-negative breast cancer (TNBC), at earlier ages with the poorest prognosis indications (8,10,(13)(14)(15), despite having access to proper screening and standard treatments (16). There is a clear need to better understand how the molecular dynamics of tumor progression may differ among women of African descent, compared with women of European descent.…”

Racial disparity in survival from estrogen and progesterone receptor-positive breast cancer: implications for reducing breast cancer mortality disparities

“…The Breast Cancer Care in Chicago study was approved by the Institutional Review Board at the University of Illinois at Chicago, and has been described elsewhere [20, 28]. This population-based study performed case finding at all 56 diagnosing facilities in the greater Chicago area that diagnosed patients who were Chicago residents at diagnosis.…”

“…This fact can be seen in studies of survival in patients diagnosed with breast cancer [1–3] and from population-based studies that show a corresponding disparity in breast cancer mortality rates within the U.S. population [1, 4–6]. There are many potential explanations for the disparity, including differences in the quality of and access to breast cancer care [7–15], as well as differences in the incidence of aggressive breast cancer subtypes in black versus white patients [2, 10, 16–20]. Particular emphasis has been placed on the increased incidence of triple negative (TN) breast cancers, which lack targetable hormone and growth factor receptors, in black women as a major driver of outcome disparities [21].…”

Absence of an anticipated racial disparity in interval breast cancer within a large health care organization

“…In addition to having more aggressive tumors, nL Black women also appear to be less likely to have access to the highest quality breast cancer screenings, according to studies of mammography access and quality conducted in Chicago (9–15). A recent analysis from the population-based Breast Cancer Care in Chicago study revealed that nL Black breast cancer patients were more likely than their nL White counterparts to report symptomatic awareness of their breast cancer despite a recent screening mammogram (10). For these reasons, it would be reasonable to expect an excess diagnosis of IBC among nL black women.…”