Abstract P4-14-07: Understanding disparities in breast cancer care in Memphis, Tennessee
Authors: Paulus Elena M , Pritchard Frances E , Nouer Simonne S , Tolley Elizabeth A , Boyd Brandon S , Davidson Jesse T , Munene Gitonga , Fleming Martin D 
Published: May 2015

Abstract
Background: Recent literature highlights the troubling racial divide in breast cancer mortality that continues to widen in most major cities across the country. Although significant progress has been made in improving overall breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. Previous studies examine the breast cancer mortality disparity in the 50 largest U.S. cities, and Memphis demonstrates the largest breast cancer mortality disparity for African Americans (AA). The goal of this investigation is to quantify racial disparities in the context of breast cancer treatment in order to reduce disparities in recurrence and mortality for breast cancer in the city of Memphis, Tennessee.
Methods: Patients with a biopsy- proven diagnosis of breast cancer over a 10 year period ending December 31, 2012 were obtained from the tumor registry of a university hospital system. Females of Caucasian and African-American race were included, while males, patients less than eighteen years of age, and patients with unknown histology, clinical stage, or type of surgery were excluded. Primary outcomes measured included overall survival and recurrence. Secondary outcomes examined were stage at diagnosis by race and time from diagnosis to surgery.
Results: 3072 breast cancer patients were reviewed (41% AA). AA patients were more likely to have advanced (Stages II, III, or IV) clinical stage of breast cancer at diagnosis versus Caucasian patients. Of the 113 recurrences, 62% occurred in AA. Of the 676 deaths, 54% occurred in AA. After adjusting for race and clinical stage of breast cancer, AA breast cancer patients had a 2.0 higher odds of recurrence when compared to Caucasian breast cancer patients (95% CI 1.4, 3.0). AA breast cancer patients were 1.5 more likely to die compared to Caucasian breast cancer patients (95% CI: 1.2, 1.8), after adjusting for race, age at diagnosis, clinical stage of breast cancer, ER, PR, and HER2 status, and recurrence. AA women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery (TDS) than Caucasian women.
Conclusions: African-American patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus Caucasian patients on a citywide level in Memphis. African-American breast cancer patients have a higher odds of recurrence and mortality when compared to Caucasian breast cancer patients, after adjusting for appropriate demographic and clinical attributes. Several factors have been suggested for the disparities including racial differences in access to and utilization of screening and treatment, risk factors distributed by race and socioeconomic status (SES), biological differences such as tumor aggressiveness, and cultural factors. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients.
Citation Format: Elena M Paulus, Frances E Pritchard, Simonne S Nouer, Elizabeth A Tolley, Brandon S Boyd, Jesse T Davidson, Gitonga Munene, Martin D Fleming. Understanding disparities in breast cancer care in Memphis, Tennessee [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-14-07.