Racial and regional disparities in metastatic breast cancer.

Abstract

10516 Background: Breast cancer is the most commonly diagnosed malignancy in American women, with about 281,500 new reported cases this year, 3.8 million women living with an active or history of breast cancer, and a lifetime occurrence of 1 in 8 women in this nation. Racial disparities persist despite the advent and implementation of screening by national agencies. AA females are less likely to be diagnosed with breast cancer, and yet bear an arbitrarily high burden of mortality of this malignancy. Socioeconomic variables and lifestyle are the most plausible explanations of this discrepancy. Even in clinical trials, there remains an underrepresentation of all ethnic minorities. Encouragement of guideline based screening for all along with constant follow ups, access to health insurance and a more uniform representation in trials are the cornerstone of eliminating these disparities. Methods: Data for this study was obtained from the 2016-18 Nationwide Inpatient Sample (NIS) which comprises 20% of the total US hospital discharges. We identified all patients with a primary diagnosis of Malignant Neoplasms of Breast. In-hospital mortality, race and hospital regions for the given patients were studied. Baseline characteristics of participants were summarized using descriptive statistics. The patient population was stratified as per race, hospital region, gender, therapy they received and family history. Logistic regression was performed to derive the odds ratio while adjusting for different variables. Further details: https://www.hcup-us.ahrq.gov/ . Results: 99, 543 patients with metastatic breast cancer were identified, and almost 99% of them were females. 67% of the population was comprised of Caucasians, 16.91% African Americans (AA), 9.14% Hispanics and 3.28% Asians and Pacific Islanders (API). AAs had the most reported deaths at 5.54%, followed by APIs at 4.80% and Caucasians 4.09% (p < 0.0001). The odds of dying were significantly higher in AA population when compared to Caucasian population (OR 1.391 (1.286-1.504)), and the odds were consistently higher across all regions of the US. In terms of regional variation, it was seen that races identifying as “others' ' had significantly higher odds of dying in the North East (OR 1.646 (1.238-2.189)) and the West (OR 1.503 (1.059-2.133)). Conclusions: It is crucial to identify racial disparities in diagnosis, treatment and mortality before we devise a blueprint to tackle this incongruity. This highlights the significance of universal screening and better health insurance coverage in addition to recognition of reasons behind these differences.