Nabi Oumarou, Liu Ying, Struthers James, Lian Min
Division of General Medicine & Geriatrics, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Cancer Epidemiol Biomarkers Prev. 2024 Dec 2;33(12):1633-1639. doi: 10.1158/1055-9965.EPI-24-0488.
It remains unclear whether residential segregation impacts on clinical treatment and outcomes for ductal carcinoma in situ (DCIS), a nonobligate precursor to invasive breast cancer (IBC).
This population-based retrospective cohort study included adult non-Hispanic White and Black women diagnosed with unilateral DCIS between January 1990 and December 2015, followed through December 2016, and identified from the Surveillance, Epidemiology, and End Results dataset. County-level racialized economic segregation was measured using the Index of Concentration at the Extremes. Multilevel logistic regression and Cox proportional hazards regression accounting for county-level clustering were used to estimate the ORs of local treatment and HRs of subsequent IBC and mortality.
Of 103,898 cases, mean age was 59.5 years, 12.5% were non-Hispanic Black, 87.5% were non-Hispanic White, 97.5% underwent surgery, 64.5% received radiotherapy following breast-conserving surgery (BCS), 7.1% developed IBC, and 18.6% died from all causes. Among women living in the least versus most privileged counties, we observed higher odds of receiving mastectomy [vs. BCS; OR = 1.51; 95% confidence interval (CI), 1.35-1.69; Ptrend < 0.001] and radiotherapy following BCS(OR = 1.27; 95% CI, 1.07-1.51; Ptrend < 0.01); the risk was higher in subsequent ipsilateral IBC (HR = 1.16; 95% CI, 1.02-1.32; Ptrend = 0.04), not in breast cancer-specific mortality (HR = 1.04; 95% CI, 0.88-1.23; Ptrend = 0.56).
The results provide evidence for disparities in clinical treatment for DCIS and prognostic outcomes among women in racially and economically segregated counties.
Our findings may inform geographically targeted multilevel interventions to reduce breast cancer burden and improve breast cancer care and equity.
目前尚不清楚居住隔离是否会影响导管原位癌（DCIS）的临床治疗及预后，DCIS是浸润性乳腺癌（IBC）的一种非必然前驱病变。
这项基于人群的回顾性队列研究纳入了1990年1月至2015年12月期间诊断为单侧DCIS的成年非西班牙裔白人和黑人女性，随访至2016年12月，并从监测、流行病学和最终结果数据集中识别出来。使用极端集中度指数来衡量县级种族化经济隔离。采用考虑县级聚类的多水平逻辑回归和Cox比例风险回归来估计局部治疗的比值比（OR）以及后续IBC和死亡率的风险比（HR）。
在103,898例病例中，平均年龄为59.5岁，12.5%为非西班牙裔黑人，87.5%为非西班牙裔白人，97.5%接受了手术，64.5%在保乳手术（BCS）后接受了放疗，7.1%发生了IBC，18.6%死于各种原因。在生活在最贫困县与最富裕县的女性中，我们观察到接受乳房切除术[与BCS相比；OR = 1.51；95%置信区间（CI），1.35 - 1.69；P趋势< 0.001]和BCS后放疗的几率更高（OR = 1.27；95% CI，1.07 - 1.51；P趋势< 0.01）；后续同侧IBC的风险更高（HR = 1.16；95% CI，1.02 - 1.32；P趋势 = 0.04），而乳腺癌特异性死亡率方面则不然（HR = 1.04；95% CI，0.88 - 1.23；P趋势 = 0.56）。
研究结果为种族和经济隔离县的女性在DCIS临床治疗和预后方面的差异提供了证据。
我们的研究结果可能为地理定位的多水平干预措施提供信息，以减轻乳腺癌负担并改善乳腺癌护理及公平性。
