University of Massachusetts Chan Medical School, Worcester, MA, USA.
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Ann Surg Oncol. 2022 Dec;29(13):7977-7987. doi: 10.1245/s10434-022-12302-9. Epub 2022 Aug 11.
Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups.
Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status.
Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18-1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51-1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease.
Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.
尽管美国（US）的西班牙裔人口由多个社区组成，但之前的乳腺癌研究通常将该群体作为一个整体进行分析。我们的目的是确定美国人群中乳腺癌分期呈现的差异，特别关注西班牙裔亚组。
使用 2004 年至 2017 年国家癌症数据库（NCDB）的数据选择患有原发性乳腺癌的女性；根据种族和族裔亚组以及西班牙裔原籍国对个体进行分类。使用有序逻辑回归创建具有 95%置信区间（CI）的调整优势比（aOR），较高的比值表示呈现较晚期乳腺癌。根据肿瘤受体状态进行亚组分析。
总体而言，在 2282691 名女性（5.2%为西班牙裔）中，西班牙裔女性更有可能居住在低收入和低教育程度的社区，并且更有可能没有保险。与非西班牙裔白人女性相比，西班牙裔女性也更有可能呈现较晚期原发性乳腺癌（aOR 1.19，95%CI 1.18-1.21；p<0.01）。当按原籍国对人群进行分类时，显示出了分期差异，特别是对于墨西哥裔女性（aOR 1.55，95%CI 1.51-1.60；p<0.01）。在三阴性疾病女性中，种族和原籍国亚组的差异都在恶化。
在按种族亚组和原籍国分类时，观察到西班牙裔人群的乳腺癌分期较晚。社会经济差异以及在获取和/或护理方面未被捕获的差异可能导致了这些观察到的差异。需要使用分类数据进行未来研究，以描述西班牙裔社区的结局并制定有针对性的干预措施。
