Abstract B112: Influence of cholesterol screening on breast cancer detection and survival in the Breast Cancer Care in Chicago Study
Authors: Kaushiva Alpana , Hong Susan , Tossas-Milligan Katherine , Rauscher Garth 
Published: August 2020

Background: The utilization of non-cancer-related screening tests may result in a screening-related comorbidity that also serves as a marker for overall increased preventive health care use, including for breast cancer detection. Previous studies have found that a diagnosis of either hypertension or cholesterol has been associated with earlier stage at diagnosis for breast cancer. We sought to replicate these findings in a racially and ethnically diverse sample of patients in the population-based Breast Cancer Care in Chicago (BCCC) study.

Methods: Participants included 989 non-Hispanic White (NHW), African American (AA), and Hispanic female breast cancer patients diagnosed between 2005 to 2008 who completed an interview. All patients resided in Chicago, Illinois, and were between the ages of 30-79 years at the time of their first primary in situ or invasive breast cancer diagnosis. Comorbid conditions were defined from interviews and medical record abstractions. Multivariable logistic regression and Cox proportional hazards (PH) models were used to estimate the associations of comorbid conditions with mode of detection (screen-detected vs. symptomatic), breast cancer-specific survival (BCSS), and overall survival (OS).

Results: Overall, 33% of BC patients had hypertension and 9% had high cholesterol (HC). A diagnosis of hypertension was not associated with mode of breast cancer detection or survival. Screen-detection was nearly 30 percentage points higher for patients with vs. without a diagnosis of HC (78% vs. 49%, PD=0.29, 95% CI: 0.19, 0.39). HC was present in 9% of NHW BC patients and 8% of AA and Hispanic BC patients. The association of HC with screen-detection varied widely by race/ethnicity, being strongest among AA patients (PD=0.41, 95% CI: 0.28, 0.54), more moderate for NHW patients (PD=0.27, 95% CI: 0.14, 0.40), and absent among Hispanic patients (PD=0.05, 95% CI: -0.21, 0.31). With adjustment for age, race/ethnicity, income, education, affluence, disadvantage, insurance status, presence of a regular provider, and time of last clinical breast exam and last mammogram, HC remained associated with screen-detection (PD=0.21, 95%CI: 0.10, 0.32). A diagnosis of high cholesterol was associated with a large but imprecise reduction in age-adjusted BCSS (HR=0.43, 95% CI: 0.14, 1.3) and OS (HR=0.50, 95% CI: 0.21, 1.1). Multivariable-adjusted HRs were 0.54 (95% 0.17, 1.7) and 0.55 (0.24, 1.2), respectively.

Conclusion: High cholesterol may be a potent marker for contact with a primary care physician and willingness to utilize preventive services. We found a particularly strong association of high cholesterol with early detection among AA patients. This association remained after robust control for preventive breast health care variables, suggesting that it is an independent predictor of screen-detected BC. A larger study is required to have sufficient sample to examine subsequent associations with BCSS and OS among racial/ethnic subgroups.

Citation Format: Alpana Kaushiva, Susan Hong, Katherine Tossas-Milligan, Garth Rauscher. Influence of cholesterol screening on breast cancer detection and survival in the Breast Cancer Care in Chicago Study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B112.