Association Identified Between Surgical and Socioeconomic Disparities and Rapid Relapse in Triple-Negative Breast Cancer

Contemporary Concepts | <b>Contemporary Concepts in Breast Cancer</b>

Patients have higher odds of experiencing rapid relapse in triple-negative breast cancer if they have Medicaid or no insurance, are single, are Black, and have not undergone surgery.

Disparities in socioeconomic status, as well as surgical disparities appear to have an association with rapid relapse in triple-negative breast cancer (rrTNBC), according to a study published in Annals of Surgical Oncology.

Investigators noted that a higher proportion of patients who developed rrTNBC had not undergone surgery (11.7%) compared with those who did not undergo surgery and did not develop rrTNBC (2.6%). Among those who received surgery but did not undergo axillary staging 6.2% of patients had and 4.5% did not have rrTNBC.

Several factors were associated with a higher risk of rrTNBC:

  • Black race (OR, 1.22; 95% CI, 1.05-1.43; P = .01)
  • Medicaid (OR, 1.53; 95% CI, 1.31-1.79; P< .001) or no insurance (OR, 1.74; 95% CI, 1.31-2.32; P< .001)
  • Individuals with a single marital status (OR, 1.19; 95% CI, 1.01-1.39; P = .03)
  • No breast (OR, 2.35; 95% CI, 1.77-3.11; P< .001)
  • No axillary surgery (OR, 1.44; 95% CI, 1.13-1.83; P = .003)

“Rapid relapse among [patients with] TNBC is associated with a combination of aggressive tumor biology and socioeconomic factor. Moreover, patients with rrTNBC are less likely to be recommended guideline concordant surgical care or to undergo appropriate locoregional management. Future studies should interrogate more granular treatment facility, provider, and patient-related variables that might be contributing to disparities in surgical malmanagement among rrTNBC patients,” investigators concluded.

The study examined 17,369 patients with TNBC who were between the ages of 18 to 64 years old, of whom 1378 had rrTNBC. The majority of patients within the cohort were between the ages of 51 to 60 years old in addition to being insured, married or partnered, non-Hispanic White, ductal histology, local stage, were poorly differentiated in grade, and lived in large metropolitan areas.

Investigators identified statistically significant differences among treatment variables between rrTNBC and non-rrTNBC for patients based on treatment with breast surgery (P< .001), axillary surgery (P< .001), and radiation (P < .001). No notable differences were identified between the groups for those who received chemotherapy (P = .26). Patients who had regional vs local stage had higher odds of developing rrTNBC (OR, 4.36; 95% CI, 3.77-5.03; P < .001).

Those who had a well differentiated grade (OR, 0.33; 95% CI, 0.15-0.77; P = .01) or who were moderately differentiated (OR, 0.71; 95% CI, 0.58-0.87; P = .001) had a lower odds of having rrTNBC compared with those with a poorly differentiated grade or those who underwent treatment with radiation vs no radiation (OR, 0.44; 95% CI, 0.34-0.57; P < .001).

Reference

Obeng-Gyasi S, Asad S, Fisher JL, Rahurkar S, Stover DG. Socioeconomic and surgical disparities are associated with rapid relapse in patients with triple-negative breast cancer. Ann Surg Oncol. Published Online February 14, 2021.doi:10.1245/s10434-021-09688-3