Hansford Rebecca L, Wilson Brooke, Griffiths Rebecca, Mahar Alyson L
Department of Public Health Sciences, Queen's University, Kingston, ON, Canada; Cancer Care & Epidemiology, Sinclair Cancer Research Institute, Queen's University, Kingston, ON, Canada.
Cancer Care & Epidemiology, Sinclair Cancer Research Institute, Queen's University, Kingston, ON, Canada; Department of Oncology, Kingston General Hospital, Kingston, ON, Canada.
Breast. 2025 May 27;82:104509. doi: 10.1016/j.breast.2025.104509.
Adults with intellectual or developmental disabilities (IDD) diagnosed with breast cancer are more likely to die than those without IDD. Differences in breast cancer treatment among individuals with and without IDD could contribute to survival disparities. We compared breast cancer treatment receipt among adults with and without IDD.
A population-based retrospective cohort study was conducted using administrative data. We included adult females diagnosed with stage I-III breast cancer in Ontario (2007-2018). IDD status was identified using an established algorithm. We estimated associations between IDD and surgical resection, adjuvant chemotherapy, and radiation using cause-specific hazards models in four distinct cohorts determined by stage and treatment eligibility. Unadjusted and adjusted hazard ratios (HR; adjusted for region, rurality, previous cancer, stage and year of diagnosis) with 95 % confidence intervals are reported, accounting for the competing event of death. Cancer subtype was not adjusted for as about 25 % of participants were missing this information. Effect modification by age, stage and comorbidity was explored.
The four cohorts included 100,679 (IDD = 369), 12,526 (IDD = 57), 60,279 (IDD = 167), and 7891 individuals (IDD = 22), respectively. Relative to those without IDD, people with IDD were less likely to receive surgical resection (HR = 0.84; 0.76-0.94), breast conserving surgery (HR = 0.69; 0.60-0.80), adjuvant chemotherapy (HR = 0.49; 0.32-0.74), and radiation (HR = 0.58; 0.46-0.73). People with IDD were as likely to receive mastectomy (HR = 1.13; 0.97-1.33). Significant interactions by age and IDD were detected for receipt of mastectomy (interaction p-value = 0.03) and breast conserving surgery (interaction p-value = 0.02).
Research to understand treatment decision-making, the accessibility of breast cancer treatment, and to examine potential pathways to improve receipt of guideline-recommended care are needed to inform targeted improvements in care delivery.
被诊断患有乳腺癌的成年智力或发育障碍（IDD）患者比无IDD的患者更有可能死亡。有和没有IDD的个体在乳腺癌治疗方面的差异可能导致生存差距。我们比较了有和没有IDD的成年人接受乳腺癌治疗的情况。
使用行政数据进行了一项基于人群的回顾性队列研究。我们纳入了安大略省（2007 - 2018年）被诊断患有I - III期乳腺癌的成年女性。使用既定算法确定IDD状态。我们在由分期和治疗资格确定的四个不同队列中，使用特定病因风险模型估计IDD与手术切除、辅助化疗和放疗之间的关联。报告未调整和调整后的风险比（HR；针对地区、农村地区、既往癌症、分期和诊断年份进行调整）及95%置信区间，同时考虑死亡这一竞争事件。由于约25%的参与者缺少癌症亚型信息，因此未对其进行调整。探讨了年龄、分期和合并症的效应修饰作用。
这四个队列分别包括100,679人（IDD = 369）、12,526人（IDD = 57）、60,279人（IDD = 167）和7891人（IDD = 22）。与无IDD的人相比，有IDD的人接受手术切除（HR = 0.84；0.76 - 0.94）、保乳手术（HR = 0.69；0.60 - 0.80）、辅助化疗（HR = 0.49；0.32 - 0.74）和放疗（HR = 0.58；0.46 - 0.73）的可能性较小。有IDD的人接受乳房切除术的可能性与无IDD的人相同（HR = 1.13；0.97 - 1.33）。在接受乳房切除术（交互作用p值 = 0.03）和保乳手术（交互作用p值 = 0.02）方面，检测到年龄与IDD之间存在显著交互作用。
需要开展研究以了解治疗决策、乳腺癌治疗的可及性，并检查改善指南推荐治疗接受情况的潜在途径，为有针对性地改善医疗服务提供依据。
