Tumor Biology, Social Determinants Equally Contribute to Breast Cancer Disparities

THURSDAY, Feb. 23, 2023 (HealthDay News) — Social determinants of health and tumor biology contribute roughly equally to racial disparities in cancer-related death among Black and White women with breast cancer, according to a study published online Feb. 16 in JAMA Oncology.

Kent F. Hoskins, M.D., from the University of Illinois at Chicago, and colleagues estimated the proportion of the Black-White disparity in breast cancer survival from estrogen receptor-positive, axillary node-negative breast cancer that is associated with adverse social determinants and high-risk tumor biology. The Surveillance, Epidemiology, and End Results Oncotype registry was used to identify 60,137 women diagnosed between 2004 and 2015 with follow-up through 2016.

The researchers found that the age-adjusted hazard ratio for breast cancer mortality among Black compared with White women was 1.82; neighborhood disadvantage and insurance status together mediated 19 percent of the disparity (mediated hazard ratio, 1.62), and tumor biological characteristics mediated 20 percent (mediated hazard ratio, 1.56). Forty-four percent of the racial disparity (mediated hazard ratio, 1.38) was accounted for in a fully adjusted model including all covariates. For probability of high-risk recurrence score, neighborhood disadvantage mediated 8 percent of the racial difference.

“Racial differences in indicators of aggressive tumor biology that included a genomic biomarker mediated the same proportion of the survival disparity as individual and neighborhood disadvantage,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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