The Role of Residential Segregation in Treatment and Outcomes of Ductal Carcinoma In Situ of the Breast

Overview

Journal Cancer Epidemiol Biomarkers Prev

Specialties Biochemistry
Oncology
Public Health

Date 2024 Sep 18

PMID 39292206

Authors

Oumarou Nabi

Ying Liu

James Struthers

Min Lian

Affiliations

Soon will be listed here.

Abstract

Background: It remains unclear whether residential segregation impacts on clinical treatment and outcomes for ductal carcinoma in situ (DCIS), a nonobligate precursor to invasive breast cancer (IBC).

Methods: This population-based retrospective cohort study included adult non-Hispanic White and Black women diagnosed with unilateral DCIS between January 1990 and December 2015, followed through December 2016, and identified from the Surveillance, Epidemiology, and End Results dataset. County-level racialized economic segregation was measured using the Index of Concentration at the Extremes. Multilevel logistic regression and Cox proportional hazards regression accounting for county-level clustering were used to estimate the ORs of local treatment and HRs of subsequent IBC and mortality.

Results: Of 103,898 cases, mean age was 59.5 years, 12.5% were non-Hispanic Black, 87.5% were non-Hispanic White, 97.5% underwent surgery, 64.5% received radiotherapy following breast-conserving surgery (BCS), 7.1% developed IBC, and 18.6% died from all causes. Among women living in the least versus most privileged counties, we observed higher odds of receiving mastectomy [vs. BCS; OR = 1.51; 95% confidence interval (CI), 1.35-1.69; Ptrend < 0.001] and radiotherapy following BCS(OR = 1.27; 95% CI, 1.07-1.51; Ptrend < 0.01); the risk was higher in subsequent ipsilateral IBC (HR = 1.16; 95% CI, 1.02-1.32; Ptrend = 0.04), not in breast cancer-specific mortality (HR = 1.04; 95% CI, 0.88-1.23; Ptrend = 0.56).

Conclusions: The results provide evidence for disparities in clinical treatment for DCIS and prognostic outcomes among women in racially and economically segregated counties.

Impact: Our findings may inform geographically targeted multilevel interventions to reduce breast cancer burden and improve breast cancer care and equity.

References

Kirchner T, Villanti A, Cantrell J, Anesetti-Rothermel A, Ganz O, Conway K . Tobacco retail outlet advertising practices and proximity to schools, parks and public housing affect Synar underage sales violations in Washington, DC. Tob Control. 2014; 24(e1):e52-8. DOI: 10.1136/tobaccocontrol-2013-051239. View

Macleod U, Ross S, Twelves C, George W, Gillis C, Watt G . Primary and secondary care management of women with early breast cancer from affluent and deprived areas: retrospective review of hospital and general practice records. BMJ. 2000; 320(7247):1442-5. PMC: 27387. DOI: 10.1136/bmj.320.7247.1442. View

Forbes J, Sestak I, Howell A, Bonanni B, Bundred N, Levy C . Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet. 2015; 387(10021):866-73. PMC: 4769326. DOI: 10.1016/S0140-6736(15)01129-0. View

Krieger N, Feldman J, Kim R, Waterman P . Cancer Incidence and Multilevel Measures of Residential Economic and Racial Segregation for Cancer Registries. JNCI Cancer Spectr. 2019; 2(1):pky009. PMC: 6649696. DOI: 10.1093/jncics/pky009. View

Berkman A, Cole B, Ades P, Dickey S, Higgins S, Trentham-Dietz A . Racial differences in breast cancer, cardiovascular disease, and all-cause mortality among women with ductal carcinoma in situ of the breast. Breast Cancer Res Treat. 2014; 148(2):407-13. PMC: 4372117. DOI: 10.1007/s10549-014-3168-3. View

Krieger N, Feldman J, Waterman P, Chen J, Coull B, Hemenway D . Local Residential Segregation Matters: Stronger Association of Census Tract Compared to Conventional City-Level Measures with Fatal and Non-Fatal Assaults (Total and Firearm Related), Using the Index of Concentration at the Extremes (ICE) for.... J Urban Health. 2017; 94(2):244-258. PMC: 5391325. DOI: 10.1007/s11524-016-0116-z. View

Berkman A, Trentham-Dietz A, Dittus K, Hart V, Vatovec C, King J . Health behavior change following a diagnosis of ductal carcinoma in situ: An opportunity to improve health outcomes. Prev Med. 2015; 80:53-9. PMC: 4592364. DOI: 10.1016/j.ypmed.2015.03.020. View

Oseni T, Zhang B, Coopey S, Gadd M, Hughes K, Chang D . Twenty-Five Year Trends in the Incidence of Ductal Carcinoma in Situ in US Women. J Am Coll Surg. 2019; 228(6):932-939. DOI: 10.1016/j.jamcollsurg.2019.01.018. View

Gu J, Groot G, Boden C, Busch A, Holtslander L, Lim H . Review of Factors Influencing Women's Choice of Mastectomy Versus Breast Conserving Therapy in Early Stage Breast Cancer: A Systematic Review. Clin Breast Cancer. 2018; 18(4):e539-e554. DOI: 10.1016/j.clbc.2017.12.013. View

10.

Liu Y, West R, Weber J, Colditz G . Race and risk of subsequent aggressive breast cancer following ductal carcinoma in situ. Cancer. 2019; 125(18):3225-3233. PMC: 6717007. DOI: 10.1002/cncr.32200. View

11.

Mannu G, Wang Z, Broggio J, Charman J, Cheung S, Kearins O . Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study. BMJ. 2020; 369:m1570. PMC: 7251423. DOI: 10.1136/bmj.m1570. View

12.

Fisher B, Dignam J, Wolmark N, Wickerham D, Fisher E, Mamounas E . Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999; 353(9169):1993-2000. DOI: 10.1016/S0140-6736(99)05036-9. View

13.

Schrijvers C, Coebergh J, Mackenbach J . Socioeconomic status and comorbidity among newly diagnosed cancer patients. Cancer. 1997; 80(8):1482-8. View

14.

Russell E, Kramer M, Cooper H, Thompson W, Jacob Arriola K . Residential racial composition, spatial access to care, and breast cancer mortality among women in Georgia. J Urban Health. 2011; 88(6):1117-29. PMC: 3232421. DOI: 10.1007/s11524-011-9612-3. View

15.

Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C . Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010; 2010(41):162-77. PMC: 5161078. DOI: 10.1093/jncimonographs/lgq039. View

16.

Firebaugh G, Farrell C . Still Large, but Narrowing: The Sizable Decline in Racial Neighborhood Inequality in Metropolitan America, 1980-2010. Demography. 2015; 53(1):139-64. PMC: 4740731. DOI: 10.1007/s13524-015-0447-5. View

17.

Noone A, Lund J, Mariotto A, Cronin K, McNeel T, Deapen D . Comparison of SEER Treatment Data With Medicare Claims. Med Care. 2014; 54(9):e55-64. PMC: 4981219. DOI: 10.1097/MLR.0000000000000073. View

18.

Feldman J, Waterman P, Coull B, Krieger N . Spatial social polarisation: using the Index of Concentration at the Extremes jointly for income and race/ethnicity to analyse risk of hypertension. J Epidemiol Community Health. 2015; 69(12):1199-207. PMC: 4878399. DOI: 10.1136/jech-2015-205728. View

19.

Lian M, Perez M, Liu Y, Schootman M, Frisse A, Foldes E . Neighborhood socioeconomic deprivation, tumor subtypes, and causes of death after non-metastatic invasive breast cancer diagnosis: a multilevel competing-risk analysis. Breast Cancer Res Treat. 2014; 147(3):661-70. PMC: 4181526. DOI: 10.1007/s10549-014-3135-z. View

20.

Fischer N, Duffy E, Michos E . Protecting Our Youth: Support Policy to Combat Health Disparities Fueled by Targeted Food Advertising. J Am Heart Assoc. 2020; 10(1):e018900. PMC: 7955455. DOI: 10.1161/JAHA.120.018900. View