Abstract PS7-41: Breast cancer outcomes among a diverse racial/ethnic south Florida population
Authors: Yadegarynia Sina , Kelly Kristin , Choi Seraphina , Kesmodel Susan , Goel Neha 
Published: February 2021

Abstract
Background: Breast cancer is the most common cancer diagnosed among Hispanic women in the US and is the leading cause of cancer-related death in this population. However, controversy remains as to whether this population has improved, or worse, overall survival (OS) outcomes compared to their non-Hispanic White (NHW) and non-Hispanic Black (NHB) counterparts. Given our location in South Florida, where Hispanics account for approximately 70% of the population we are perfectly poised to analyze breast cancer overall survival (OS) outcomes in a Hispanic population compared to a non-Hispanic population. Furthermore, given the diverse nature of our Hispanic population, this is the first study to also evaluate outcomes in Hispanic Whites (HW) compared to Hispanic Blacks (HB).
Methods: Patients presenting to our medical campus with stage I-IV breast cancer from 2005-2017 were identified from the local tumor registry. Kaplan-Meier survival analysis was performed to identify patient, tumor, and NCCN-guideline based treatment characteristics associated with OS. Factors with a p &lt; 0.1 were included in the Cox proportional hazards model.
Results: 5,951 breast cancer patients were evaluated from 2005-2017. Patient demographics, tumor characteristics, and treatments received are presented in Table 1. NHB tended to be more economically disadvantaged, presented with later stage disease, had rates higher triple negative disease, and were less likely to complete NCCN-guideline based treatment. The 5-year OS across all races/ethnicities was 82.5% with a median follow-up of 65 months. The 5-year OS stratified by race and ethnicity is as follows: NHW 85%, HW 84.8%, HB 79.4%, and NHB 72.7%. On Cox proportional hazards model, when adjusting for stage, race/ethnicity, insurance, marital status, income, smoking/alcohol, receptor status, tumor grade, and NCCN-guideline based treatment, NHB had a hazard ratio of 1.25 [(95% CI:1.01-1.52), p&lt; 0.041)].
Conclusion: At our institution, located in South Florida, we treat a large number of patients with breast cancer from South Florida, Central and South America, and the Caribbean who self-report as Hispanic. Our study is the first to suggest survival differences amongst HW and HB. Moreover, HB had improved OS compared to NHB, suggesting unaccounted for protective factors associated with Hispanic ethnicity.
Table 1: Patient demographics, tumor, and treatment characteristicsFactorNHWHispanic WhiteNHBHispanic BlackAllp-valueN=1647N=3127N=1070N=107N=5951PATIENT DEMOGRAPHICSAge at diagnosisp&lt;0.001&lt;50 years441 (26.8%)990 (31.7%)358 (33.5%)30 (28.0%)1819 (30.6%)50-69 years898 (54.5%)1769 (56.6%)607 (56.7%)62 (57.98%)3336 (56.1%)70-79 years205 (12.4%)279 (8.9%)76 (7.1%)14 (13.1%)574 (9.6%)80+ years103 (6.3%)89 (2.8%)29 (2.7%)1 (0.9%)222 (3.7%)Birthplacep&lt;0.001US-born778 (47.2%)139 (4.4%)482 (45.0%)4 (3.7%)1403 (23.6%)Foreign-born214 (13.0%)2307 (73.8%)430 (40.2%)92 (86.0%)3043 (51.1%)Unknown655 (39.8%)681 (21.8%)158 (14.8%)11 (10.3%)1505 (25.3%)Relationshipp&lt;0.001Married947 (57.5%)1462 (46.8%)355 (33.2%)34 (31.8%)2798 (47.0%)Single295 (17.9%)756 (24.2%)472 (44.1%)42 (39.3%)1565 (26.3%)Divorced/Separated/Widow346 (21.0%)832 (26.6%)218 (20.4%)28 (26.2%)1424 (23.9%)Other/Unknown59 (3.6%)77 (2.5%)25 (2.3%)3 (2.8%)164 (2.8%)Area Deprivation Index35.4 ± 27.252.8 ± 26.767.0 ± 23.166.1 ± 23.850.9 ±28.3p&lt;0.001Median Income Quartilesp&lt;0.001&lt;$36,572130 (8.0%)909 (29.8%)405 (39.6%)40 (38.1%)1484 (25.6%)$36,573-48,450317 (19.6%)787 (25.8%)384 (37.5%)32 (30.5%)1520 (26.2%)$48,451-64,599521 (32.3%)700 (22.9%)143 (14.0%)26 (24.8%)1390 (24.0%)&gt;$64,600649 (40.1%)658 (21.5%)91 (8.9%)7 (6.7%)1405 (24.2%)Insurancep&lt;0.001Private1054 (64.0%)1111 (35.5%)397 (37.1%)24 (22.4%)2586 (43.5%)Medicare320 (19.4%)343 (11.0%)117 (10.9%)16 (15.0%)796 (13.4%)Medicaid94 (5.7%)716 (22.9%)276 (25.8%)34 (31.8%)1120 (18.8%)Uninsured72 (4.4%)667 (21.3%)187 (17.5%)28 (26.2%)954 (16.0%)TUMOR AND TREATMENT CHARACTERISTICSClinical Stagep&lt;0.001I765 (46.4%)1137 (36.4%)281 (26.3%)28 (26.2%)2211 (37.2%)II512 (31.1%)1120 (35.8%)386 (36.1%)38 (35.5%)2056 (34.5%)III211 (12.8%)563 (18.0%)221 (20.7%)24 (22.4%)1019 (17.1%)IV122 (7.4%)226 (7.2%)141 (13.2%)14 (13.1%)503 (8.5%)Unknown37 (2.2%)81 (2.6%)41 (3.8%)3 (2.8%)162 (2.7%)Tumor Gradep&lt;0.001Well diff.334 (20.3%)531 (17.0%)132 (12.3%)13 (12.1%)1010 (17.0%)Moderately diff.715 (43.4%)1341 (42.9%)370 (34.6%)46 (43.0%)2472 (41.5%)Poorly diff.415 (25.2%)959 (30.7%)450 (42.1%)37 (34.6%)1861 (31.3%)Anaplastic/Undifferentiated7 (0.4%)19 (0.6%)20 (1.9%)2 (1.9%)48 (0.8%)Unknown176 (10.7%)277 (8.9%)98 (9.2%)9 (8.4%)560 (9.4%)Receptor Statusp&lt;0.001ER+/HER2+170 (10.3%)336 (10.7%)109 (10.2%)18 (16.8%)633 (10.6%)ER+/HER2-1078 (65.5%)1983 (63.4%)525 (49.1%)60 (56.1%)3646 (61.3%)ER-/HER2-315 (19.1%)571 (18.3%)335 (31.3%)22 (20.6%)1243 (20.9%)ER-/HER2+84 (5.1%)237 (7.6%)101 (9.4%)7 (6.5%)429 (7.2%)Pathologic Stagep&lt;0.001012 (0.7%)20 (0.6%)7 (0.7%)1 (0.9%)40 (0.7%)I759 (46.2%)1086 (34.7%)281 (26.3%)31 (29.2%)2157 (36.3%)II406 (24.7%)859 (27.5%)268 (25.0%)26 (24.5%)1559 (26.2%)III146 (8.9%)340 (10.9%)106 (9.9%)12 (11.3%)604 (10.2%)IV44 (2.7%)81 (2.6%)37 (3.5%)9 (8.5%)171 (2.9%)Unknown277 (16.8%)740 (23.7%)371 (34.7%)27 (25.5%)1415 (23.8%)TreatmentsSurgery1494 (90.7%)2782 (89.0%)856 (80.0%)88 (82.2%)5220 (87.7%)p&lt;0.001Chemotherapy854 (51.9%)1891 (60.5%)658 (61.5%)61 (57.0%)3464 (58.2%)p&lt;0.001Radiation848 (51.5%)1761 (56.3%)528 (49.3%)56 (52.3%)3193 (53.7%)p&lt;0.001Endocrine Therapy1121 (68.1%)1924 (61.5%)482 (45.0%)59 (55.1%)3586 (60.3%)p&lt;0.001NCCN Guideline-Based Care (by stage and receptor)1311 (79.6%)2366 (75.7%)745 (69.6%)77 (72.0%)4499 (75.6%)p&lt;0.001Treatment at Comprehensive Cancer Center1368 (83.1%)1445 (46.2%)432 (40.4%)37 (34.6%)3282 (55.2%)p&lt;0.001
Citation Format: Sina Yadegarynia, Kristin Kelly, Seraphina Choi, Susan Kesmodel, Neha Goel. Breast cancer outcomes among a diverse racial/ethnic south Florida population [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-41.