Nguyen Antoinette, Duckworth Emily, Pascua Danielle, Coles Brigid, Galiano Robert
Department of Plastic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Department of Plastic Surgery, University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA.
J Surg Oncol. 2025 May;131(6):1002-1012. doi: 10.1002/jso.27994. Epub 2024 Nov 25.
Native Hawaiian and Pacific Islander (NHPI) women experience significant disparities in breast cancer treatment and outcomes, including lower rates of postmastectomy reconstruction, higher refusal rates of radiation therapy, and delays in surgical care. These disparities contribute to poorer survival and increased complications compared to other racial/ethnic groups. This systematic review and meta-analysis aim to quantify these disparities and assess their impact on breast cancer outcomes in NHPI women.
A comprehensive search of PubMed, Scopus, and Embase databases was conducted to identify studies reporting on breast cancer surgery, reconstruction, radiation therapy refusal, and surgical delays for NHPI women. Thirteen studies, encompassing a total of 5 546 918 patients, were included, and meta-analyses were performed to pool odds ratios (OR) and hazard ratios (HR) for key outcomes using random-effects models. Heterogeneity was assessed using I² statistics. Thematic analysis was also conducted to explore cultural and structural factors influencing treatment disparities.
NHPI women had significantly lower odds of receiving postmastectomy reconstruction compared to non-Hispanic White women (pooled OR = 2.02, 95% confidence interval [CI]: 1.96-2.08, I² = 99%). Delays in surgical care were more frequent, with NHPI women being 4.51 times more likely to experience delays (OR = 4.51, 95% CI: 3.82-5.32, I² = 99%). Radiation therapy refusal was notably higher, with a pooled hazard ratio of 3.28 (95% CI: 2.99-3.58, I² = 77%) indicating that NHPI women who refused radiation therapy had more than three times the risk of mortality compared to those who accepted it. Thematic analysis revealed that geographic isolation, limited access to specialized care, and cultural perceptions surrounding cancer treatments, including fear of radiation due to historical trauma, contributed significantly to treatment disparities.
Native Hawaiian and Pacific Islander women face considerable barriers to receiving equitable breast cancer treatment and reconstruction, resulting in worse outcomes compared to other racial/ethnic groups. Efforts to address these disparities must focus on improving access to care, reducing treatment delays, and implementing culturally sensitive interventions. Targeted policies and healthcare system improvements, especially in geographically isolated areas, are critical to improving survival and treatment outcomes for NHPI women.
夏威夷原住民和太平洋岛民（NHPI）女性在乳腺癌治疗及预后方面存在显著差异，包括乳房切除术后重建率较低、放射治疗拒绝率较高以及手术治疗延迟。与其他种族/族裔群体相比，这些差异导致生存率更低、并发症增加。本系统评价和荟萃分析旨在量化这些差异，并评估其对NHPI女性乳腺癌预后的影响。
对PubMed、Scopus和Embase数据库进行全面检索，以识别报告NHPI女性乳腺癌手术、重建、放射治疗拒绝及手术延迟情况的研究。纳入13项研究，共涉及5546918例患者，并使用随机效应模型进行荟萃分析，汇总关键结局的比值比（OR）和风险比（HR）。使用I²统计量评估异质性。还进行了主题分析，以探讨影响治疗差异的文化和结构因素。
与非西班牙裔白人女性相比，NHPI女性接受乳房切除术后重建的几率显著更低（汇总OR = 2.02，95%置信区间[CI]：1.96 - 2.08，I² = 99%）。手术治疗延迟更为常见，NHPI女性经历延迟的可能性高4.51倍（OR = 4.51，95% CI：3.82 - 5.32，I² = 99%）。放射治疗拒绝率明显更高，汇总风险比为3.28（95% CI：2.99 - 3.58，I² = 77%），表明拒绝放射治疗的NHPI女性死亡风险是接受放射治疗女性的三倍多。主题分析显示，地理隔离、获得专科护理的机会有限以及围绕癌症治疗的文化观念，包括因历史创伤而对放射治疗的恐惧，对治疗差异有显著影响。
夏威夷原住民和太平洋岛民女性在获得公平的乳腺癌治疗和重建方面面临相当大的障碍，与其他种族/族裔群体相比，预后更差。解决这些差异的努力必须集中在改善医疗服务可及性、减少治疗延迟以及实施具有文化敏感性的干预措施上。有针对性的政策和医疗系统改进，特别是在地理隔离地区，对于改善NHPI女性的生存率和治疗结局至关重要。
