Impact of Racial Disparities on Treatment of Early Triple Negative Breast Cancer Among American Indians/Alaska Natives and Non-Hispanic Whites.

BACKGROUND

Differences in patient and tumor characteristics among American Indian/Alaska Native (AI/AN) and non-Hispanic White (NHW) breast cancers (BC) adversely impact overall survival (OS) in AI/AN. The aims of this study were to: 1) investigate disparities in treatment of early triple negative breast cancers (TNBC); 2) assess differences in OS.

METHODS

A hospital-based, retrospective cohort study using the National Cancer Database included AI/AN and NHW women, 18 years or older, diagnosed with TNBC between 2010 and 2019, stages I-III. Propensity score matching (1:3 ratio) was used for age, year, and analytic stage at diagnosis.

RESULTS

A total of 489 AI/AN and 1465 available matched NHW women with TNBC were analyzed. Time to first treatment (TFT) was significantly longer for AI/AN (P = .005). Multivariate analysis revealed that longer TFT was associated with only higher Charlson-Deyo Score (CDS) (P = .014) and nonprivate insurance (P < .001), but not race (P = .568). Overall treatment compliance was similar (AI/AN - 89.6% vs. NHW - 92.2%, P = .074). Compliance was significantly associated with only insurance status (P < .001). On multivariate analysis OS did not differ by race (P = .687, HR = 1.06; 95% CI: 0.79-1.44). Cancer stage, CDS, insurance status, and treatment compliance were associated with worse OS.

CONCLUSION

In patients with TNBC, there was no difference in TFT, compliance with recommended treatment or OS among AI/AN in comparison to White women when matched for age, stage, and year of diagnosis. In order to improve BC survival, it is important to manage comorbid conditions and improve detection of cancer at earlier stages.