Surgical treatment of young women with breast cancer: Public vs private hospitals

Abstract

Disparities in breast cancer treatment have been documented in young and underserved women. This study aimed to determine whether surgical disparities exist among young breast cancer patients by comparing cancer treatment at a public safety‐net hospital (BH) and private cancer center (PCC) within a single institution. This was a retrospective study of young women (<45) diagnosed with invasive breast cancer (stage I‐III) from 2011‐2016. Patient information was abstracted from the breast cancer database at BH and PCC. Demographic variables, surgery type, method of presentation, and stage were analyzed using Pearson's chi‐square tests and binary logistic regression. A total of 275 patients between ages 25‐45 with invasive breast cancer (Stage I‐III) were included in the study. There were 69 patients from BH and 206 patients from PCC. At PCC, the majority of patients were Caucasian (68%), followed by Asian (11%), Hispanic (10%), and African American (8.7%). At BH, patients were mostly Hispanic (47.8%), followed by Asian (27.5%), and African American (10.1%). At PCC, 82% had a college/graduate degree versus 18.6% of patients at BH (P < 0.001). All patients at PCC reported English as their primary language versus 30% of patients at BH (P < 0.001). Patients at PCC were more likely to present with lower stage cancer (P = 0.04), and less likely to present with a palpable mass (P = 0.04). Hospital type was not a predictor of receipt of mastectomy (P = 0.5), nor was race, primary language, or education level. Of patients who received a mastectomy, 87% at BH and 76% at PCC had immediate reconstruction. Surgical management of young women with breast cancer in a public hospital versus private hospital setting was equivalent, even after controlling for race, primary language, stage, and education level.

Linking Structural Racism and Discrimination and Breast Cancer Outcomes: A Social Genomics Approach

“…13,14 This racial disparity in mortality has been partially attributed to racial differences in stage of presentation, 15,16 molecular subtype, [17][18][19] and disparities in treatment. 13,[20][21][22][23] Nevertheless, this mortality disparity persists even in ductal carcinoma in situ, 14 the earliest and curable stage of disease. Black women are more likely to have poor tumor prognostic features such as high-grade, more aggressive breast cancer molecular subtypes (eg, triple-negative breast cancer), and lymph node metastasis at diagnosis.…”

Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer

“…Acknowledging the disparities in healthcare is important, in order to overcome the limitations. Five studies evaluated the disparities in AYA patients who underwent surgery for breast cancer [ 69 , 70 , 71 , 73 , 75 ]. As previously discussed, the timing to surgery influenced the oncologic outcomes in one study.…”

“…That same study found that Hispanic and African American patients (compared to non-Hispanic white), patients with public or no insurance (compared to private insurance), and patients with a low socioeconomic status (compared to a high socioeconomic status) were more likely to have a treatment delay of greater than 6 weeks, which was associated with worse outcomes [ 75 ]. In other studies, surgical management was found to be equivalent in public and private hospitals [ 69 ]; however, race was associated with undergoing a CPM, with white women being twice as likely to undergo a CPM than women of other racial groups [ 73 ]. The oncologic outcomes were found to vary with marital status, with a survival benefit of BCS over mastectomy observed in unmarried patients [ 71 ].…”

Racial Disparity in Immediate Breast Reconstruction; a Gap That is not Closing

“…[2][3][4][5] Existing disparities and the call for their elimination is more than 3 decades old, yet, prior studies have conflicting findings on whether a disparity exists. [6][7][8][9] The inequity in IBR had been reported to be associated with several factors such as income, insurance type, geographical region, ethnicity and race, still the most commonly found disparity in more than 70% of prior studies is the association with race. 6 Despite the growing body of evidence on disparity, there is a paucity of studies with robust statistical methods focusing on the main cause of this disparity.…”