Black Dalliah M, Day Courtney N, Piltin Mara A, Klassen Christine L, Pruthi Sandhya, Hieken Tina J
Department of Surgery, Mayo Clinic, Rochester, MN.
Department of Health Science Research and Clinical Studies, Mayo Clinic, Rochester, MN.
Surgery. 2025 Mar;179:108940. doi: 10.1016/j.surg.2024.08.059. Epub 2024 Nov 26.
Racial differences in invasive breast cancer exist, but less is known about ductal carcinoma in situ. Our aim was to assess racial/ethnic differences in ductal carcinoma in situ tumor biology and treatment.
Adults with ductal carcinoma in situ were identified from the National Cancer Database, 2012-2021. Pairwise comparisons were evaluated among racial/ethnic groups with χ or Wilcoxon tests. Multivariable logistic regression models evaluated outcome predictors for treatment and time to treatment.
Non-Hispanic Black patients had larger mean tumor size (2.2 cm, P ≤ .001). Non-Hispanic Black and Hispanic patients more frequently presented with multicentric disease (14.7% and 14.3%, P < .001). Non-Hispanic White patients had more grade III (45.1%, P < .01) and estrogen receptor-negative disease (14.2%, P < .04). On multivariable analysis, non-White race/ethnicity patients were less likely to undergo primary-site surgery (non-Hispanic Black odds ratio, 1.80; Hispanic odds ratio, 1.23; Asian/Pacific Islander odds ratio; 1.45, vs non-Hispanic White each P ≤ .002), as were uninsured and Medicaid-insured (uninsured odds ratio, 2.76; Medicaid odds ratio, 1.39; vs private insurance, both P < .002). Asian patients were more likely to undergo mastectomy (odds ratio, 1.08; 95% confidence interval, 1.02-1.15, P = .007), along with younger age (odds ratio, 0.64, P < .001), and multicentricity (hazard ratio, 2.23, P < .001). For breast conservation, radiation was less frequent among Hispanic patients (68.8%, P < .001). For estrogen receptor-positive ductal carcinoma in situ, non-Hispanic Black patients had the greatest receipt of endocrine therapy (61.9%%, P < .001) and Asian patients the lowest (56.9%, P < .001). On multivariable analysis, non-White race/ethnicity, uninsured, and Medicaid were associated with longer times from diagnosis to first surgery and from definitive surgery to radiation start.
Racial/ethnic differences exist in ductal carcinoma in situ tumor biology and treatment, both of which may contribute to poorer outcomes in disparate groups.
浸润性乳腺癌存在种族差异，但导管原位癌方面的了解较少。我们的目的是评估导管原位癌肿瘤生物学和治疗方面的种族/民族差异。
从2012 - 2021年国家癌症数据库中识别出患有导管原位癌的成年人。通过χ检验或威尔科克森检验对种族/民族群体进行两两比较。多变量逻辑回归模型评估治疗和治疗时间的结果预测因素。
非西班牙裔黑人患者的肿瘤平均大小更大（2.2厘米，P≤0.001）。非西班牙裔黑人和西班牙裔患者更常出现多中心疾病（分别为14.7%和14.3%，P<0.001）。非西班牙裔白人患者有更多的III级（45.1%，P<0.01）和雌激素受体阴性疾病（14.2%，P<0.04）。多变量分析显示，非白人种族/民族的患者接受原发部位手术的可能性较小（非西班牙裔黑人优势比为1.80；西班牙裔优势比为1.23；亚太岛民优势比为1.45，与非西班牙裔白人相比，P均≤0.002），未参保和参加医疗补助保险的患者也是如此（未参保优势比为2.76；医疗补助优势比为1.39；与私人保险相比，P均<0.002）。亚洲患者更有可能接受乳房切除术（优势比为1.08；95%置信区间为1.02 - 1.15，P = 0.007），同时年龄较小（优势比为0.64，P<0.001），且多中心性（风险比为2.23，P<0.001）。对于保乳治疗，西班牙裔患者接受放疗较少（68.8%，P<0.001）。对于雌激素受体阳性的导管原位癌，非西班牙裔黑人患者接受内分泌治疗的比例最高（61.9%，P<0.001），而亚洲患者最低（56.9%，P<0.001）。多变量分析表明，非白人种族/民族、未参保和参加医疗补助保险与从诊断到首次手术以及从确定性手术到开始放疗的时间较长有关。
导管原位癌在肿瘤生物学和治疗方面存在种族/民族差异，这两者都可能导致不同群体的预后较差。
