Abstract P5-08-10: Stage-at-presentation and time-to-treatment for American Indian patients diagnosed with breast cancer
Authors: Algan O , Campbell JE , Algan SM 
Published: March 2017

Abstract
Purpose: To review the stage of presentation and time-to-treatment for American Indian (AI) patients diagnosed with breast cancer (BC) and compare them to White (W), Black (B), Asian (AS) and Hawaiian/Polynesian (HP) population across the US and by geographic region using a large national database.
Methods: The NCDB, a joint project of the American Cancer Society and the Commission on Cancer, is a comprehensive national database that registers approximately 70% of cancer patients in the US. Data for patients with BC was extracted from the NCDB 2013 PUF file (2004-2013). Categorical data were compared using the chi-square test. Time-to-treatment (TtT) analysis was performed in patients with non-metastatic breast cancer. All interval parameters were evaluated as continuous variables and compared using ANOVA analysis.
Results: Table 1 shows the number of patients, median age and stage at presentation by race. The median age was lowest for AS and largest for W patients. Compared to W patients, AI patients were less likely to present with stage 0/I disease and more likely to present with stage II/III disease. Similarly, AI patients were 25% more likely to present with metastatic disease when compared to W patients. Table 1 also shows the mean intervals (in days) from diagnosis to treatment. This analysis revealed significant differences amongst the races, with AI patients tending to have the second shortest TtT. Evaluation of the interval to treatment amongst the 9 geographic regions also revealed significant differences. The West North Central and East South Central regions had the shortest TtT and the Pacific and North East regions had the longest. For AI patients, the shortest TtT occurred in the West North Central and South Atlantic while the longest TtT occurred in the North East and West South Central regions. In general, the magnitude of these differences was under 20%, but varied greatly depending on the variables and regions evaluated. These differences were statistically significant (p-value &lt; 0.01).
Conclusion: AI patients presented with later stage disease and longer interval to treatment for all modalities compared to White race, but did better overall than Black patients, both for stage at diagnosis and time to treat. There was considerable regional variation in time intervals across all races. Efforts to improve outcomes should be focused on addressing regional variations in time to treat, and in earlier diagnosis of breast cancer for at risk populations.
Table 1Clinical ParametersAmerican IndianWhiteBlackAsianHawaiin / Polynesianp-valueN4,6341,623,175217,69655,9423,473 Age (Median)5761585556&lt; 0.001Stage 0 (%)17.420.521.425.519.5&lt; 0.001I35.942.031.137.335.8 II31.525.129.025.829.5 III10.78.712.48.510.8 IV4.63.76.12.94.3 Inverval from Diagnosis to: [Mean(Std Dev) in days]Treatment Start32.3 (38.8)27.8 (39.3)35.0 (39.4)31.1 (31.9)31.2 (32.9)&lt; 0.001Definitive Surgical Procedure52.7 (62.8)44.5 (52.5)61.6 (71.1)51.4 (57.3)52.0 (60.6)&lt; 0.001Start of Radiotherapy152.9 (90.5)128.0 (83.7)165.4 (99.7)144.2 (90.0)151.0 (93.2)&lt; 0.001Start of Chemotherapy76.0 (53.1)68.8 (47.8)77.7 (56.1)72.9 (52.6)78.8 (50.2)&lt; 0.001Start of HT160.7 (103.7)144.3 (101.4)171.2 (117.8)160.4 (106.9)171.5 (115.2)&lt; 0.001
Citation Format: Algan O, Campbell JE, Algan SM. Stage-at-presentation and time-to-treatment for American Indian patients diagnosed with breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-10.