Inflammatory Breast Cancer, Trimodal Treatment And Mortality: Does Where You Live Matter?
*Theresa Relation, *Yaming Li, *James L. Fisher, *Allan Tsung, *Bridget Oppong, *Miriam Eskander, Samilia Obeng-Gyasi
The Ohio State University, Columbus, OH
Objective: Zip code has been shown to be a more powerful predictor of health than one’s genetic code. For instance, low neighborhood socioeconomic status (nSES) has been associated with advanced breast cancer presentation and higher mortality. What is less known are the implications of nSES on treatment and mortality in rare breast cancers such as inflammatory breast cancer. The objective of this study is to evaluate the association between neighborhood socioeconomic status (nSES), trimodal treatment and disease specific mortality among IBC patients in the Surveillance, Epidemiology and End Results (SEER) Program.
Methods: Patients diagnosed with IBC (T4d) from 2010-2016 were identified in the SEER program. The cohort was stratified into nSES groups (low, middle, high) based on the NCI census tract-level index. The nSES index is comprised of median household income, an education index, median house value, percent working class, median rent, percent unemployed and percent below 150% of poverty level. Trimodal treatment was defined as receipt of modified radical mastectomy, chemotherapy and radiation therapy. Bivariable analysis, the log rank test and a Cox proportional hazards model were used to evaluate the relationship between nSES, trimodal treatment and disease specific mortality.
Results: 4374 patients met the study criteria. Compared to those living in neighborhoods with middle and high nSES, patients in areas with low nSES were more likely to be black (low 30.2%, middle 12.9%, high 7.9%; p<0.001), single (low 27.6%, middle 20.2%, high 17.8%; p<0.001) and Medicaid insured (low 34.9%, middle 21.9%, high 13.3%; p<0.001). There was no difference between the nSES groups on receipt of trimodal treatment (p=0.19). However, unadjusted analysis showed an association between higher disease specific mortality and living in area with a low nSES (p<0.001). On multivariable analysis, there was no association between low nSES (1.13, 0.98-1.30; ref high nSES) or middle nSES (1.01, 0.88-1.64; ref high nSES) and disease specific mortality.
Conclusions: For IBC patients in SEER, disease specific mortality appears to be driven by underlying tumor biology instead of disparities in treatment or nSES. These findings are significant as they differ from evaluations of nSES in more common breast cancer types.
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