Early Onset Breast Cancer Disparities Through An Imaging Lens: Are Black Women More Likely To Have Interval Cancers?
*Avia D Wilkerson1, *Audry Sebikali-Potts2, *Megan Obi1, *Camila Ortega1, *Holly J Pederson3, Zahraa Al-Hilli1
1Cleveland Clinic Foundation, Department of General Surgery, Cleveland, OH;2Case Western Reserve University School of Medicine, Cleveland, OH;3Cleveland Clinic Foundation, Department of Breast Services, Cleveland, OH
Disparately higher mortality among Black women with breast cancer is well documented; however, these disparities are further amplified in the setting of early onset breast cancer (EOBC). Black women diagnosed with breast cancer before age 50 are fifty percent more likely to die from the disease, in part due to later presentation and more aggressive tumor biology. Accordingly, we sought to determine whether interval cancers were also higher in young Black women. METHODS:
Demographic, mammographic, and clinico-pathologic data were obtained from 724 women ages 40-45 who underwent oncologic surgery for breast cancer at our institution between 2010 and 2019. We defined interval cancers as breast cancers diagnosed between the time point at which a screening mammogram was read as negative, benign, or likely benign and the next recommended screening mammogram. A logistic regression model was applied to assess the association of collected variables with detection of an interval cancer by racial/ethnic group. RESULTS:
In the overall cohort of 729 patients, the mean age at breast cancer diagnosis was similar across ethnic groups (42.8 years, p=0.624). Black women were more likely to have a BMI greater than 30 (p=<0.001), to be current smokers (p=0.033), to have a variant of unknown significance on germline genetic testing (p=0.049), present with more advanced disease. We observed a trend towards more interval cancers in Black women (14/82, 17.1%) compared to Asian (2/21, 9.5%) and White women (79/596%, 13.3%), though no statistical significance was reached (p=0.549). CONCLUSIONS:
Screening recommendations for women age 40-45 vary, which may disproportionately affect detection and survival among young Black women, whom are significantly more likely to be diagnosed with EOBC. Our data suggests a trend toward more frequent interval breast cancers among Black women which warrants further investigation, as interval cancers have previously been demonstrated to be associated with more advanced disease at diagnosis and increased mortality. Our data demonstrates the importance of early risk stratification in this group and a potential role for earlier or enhanced screening protocols.
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