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Examining Racial Differences In Surgical Management And Survival Among Patients With Paget's Disease Of The Breast
*Nicci Owusu-Brackett1, *JC Chen1, *Yaming LI2, *James L. Fisher1, *Oindrila Bhattacharyya3, Samilia Obeng-Gyasi1
1The Ohio State University, Columbus, OH;2Pittsburg University, Pittisburg, PA;3Indiana University Purdue University, Indianapolis, IN

OBJECTIVE(S):The objective of this study is to evaluate racial differences in surgical management and survival among patients with Paget’s disease of the breast in the Surveillance, Epidemiology and End Result (SEER) program.
METHODS: SEER was queried for female patients ages 18+ presenting with localized or regional Paget’s disease of breast between 01/01/2010-12/31/2016. The sample was divided into Black and White patients. Bivariable analysis was used to compare the groups on sociodemographic factors, clinical variables, and surgery utilization. Using propensity score matching, Black patients were nearest matched to white patients (1:2) on age at diagnosis, stage, surgery, chemotherapy, and year of diagnosis. A Kaplan-Meier curve was used to evaluate overall survival between the two groups in the matched sample.
RESULTS: There were 1,181 patients who met the study criteria with a racial distribution of 88.8% White and 11.2% Black. Black patients were younger (59.8 years±15.17 vs 64.3years±14.3; p<0.001), more likely to report single marital status (23.5% vs 11.9%, p<0.001), Medicaid insurance (25.8 vs 11.1%; <0.001) and residence in neighborhoods with low socioeconomic status (53% vs 25.4%; p<0.001) than White patients. Additionally, compared to White patients, Black patients had higher proportions of poorly differentiated tumors (49.2% vs 45.2%; p=0.016) and more advanced disease (regional 41.7% vs 29.0%, p<0.001). Interestingly, there was no significant difference between the groups on breast cancer subtypes (p=0.094). Moreover, there were no significant racial differences in surgery utilization (lumpectomy 28.7 vs 28%; mastectomy 66.8% vs 67.6% and no surgery 3.1% vs 4.6%, p=0.23), contralateral prophylactic mastectomy (21.3% vs 22.7% p=0.76) or axillary staging (axillary staging 73.7% vs73.1%, p=0.25). However, on Kaplan-Meier analysis of the matched cohort, Black patients had a worse overall survival compared to White patients (p=0.05).
CONCLUSIONS: In our evaluation of Paget’s disease of the breast in SEER, there were no racial disparities in surgical management. However, after matching on treatment and clinical characteristics, Black breast cancer patients had a worse overall survival than their White counterparts. Future studies should focus on interactions between social determinants of health and tumor characteristics as drivers of racial disparities in survival from Paget’s disease of the breast.


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