Black race, lower-income status linked to higher mortality risk in breast cancer subgroup
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Key takeaways:
- Socioeconomic disparities impact outcomes of women with HER2-positive breast cancer and brain metastases.
- Black women and those with lower-income status had a higher mortality risk beyond 1 year after diagnosis.
Black women with HER2-positive breast cancer and brain metastases appeared at higher risk for mortality than their white counterparts, according to study results published in Journal of the National Comprehensive Cancer Network.
Researchers also reported an association of lower-income status with increased mortality risk beyond 1 year after diagnosis among this patient population.
Rationale and methodology
Socioeconomic disparities have been reported across various cancer types in different regions of the world, Akhil Jain, MD, resident physician at Mercy Catholic Medical Center in Darby, Pennsylvania, told Healio.
“Although survival in patients with breast cancer, including HER2/neu overexpression, has been improving, the presence of brain metastasis still confers a poor prognosis or outcome for such patients,” Jain said. “We consider race and income status as important social determinants in the outcomes of patients with cancer, so we were interested in studying the impact of these factors.”
Jain and colleagues used the SEER database to identify 427 women diagnosed with HER2-positive breast cancer and brain metastases who received chemotherapy between 2010 and 2018. They grouped women into two cohorts: low income (annual median household income less than $75,000) and high income (annual median household income more than $75,000). The low-income cohort included 66% of women in the study.
Researchers used log-rank test and Cox regression analysis to study survival during the study period and calculated Kaplan-Meier survival curves. They conducted subgroup analyses for survival of less than and more than 1 year.
Findings
Results showed women in the lower-income group experienced a significantly higher risk for mortality compared with women in the higher-income group during the study period (P = .0037).
Subgroup analysis showed Black women (HR = 1.64; P = .04) and those in lower-income groups (HR = 1.55; P = .02) experienced higher mortality risk after 1 year.
Implications
The findings suggest that Black race and lower-income status are important social determinants of poor outcomes, Jain told Healio.
“HER2/neu overexpression of breast cancer is targeted by immunotherapies and sequential use of such immunotherapies in a metastatic setting has financial limitations, as well,” he said. “Using our research concept, further exploration of real-world data or other retrospective or prospective registries may clarify more on the utility of various chemotherapeutic or immunotherapy agents or regimens that have shown better results in certain groups of patients with breast cancer than others. Proactively advocating for breast cancer screening and thereafter providing treatment options to high-risk women may also be helpful in mitigating the outcome differences due to such social determinants.”
For more information:
Akhil Jain, MD, can be reached at akhiljaindr@gmail.com.
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