Abstract B19: Associations among race/ethnicity, geography, and breast cancer incidence and mortality in Trinidad and Tobago
Authors: Warner Wayne A. , Lee Yee Lam , Ramnarine Shelina , Slovacek Simeon , Roach Veronica , Ellis Matthew , Llanos Adana 
Published: October 2015

Abstract
Background: Breast cancer (BC) is clearly a major global public health concern. This concern is more evident in developing countries like Trinidad and Tobago (TT) where BC mortality rates are among the highest in the Caribbean and the world. This twin island nation has a population of 1,328,019 of multicultural ancestries including East Indian (35%), African (34%) and mixed ancestry (23%). TT is the most industrialized of all Caribbean nations and offers comprehensive, no-cost healthcare to all citizens. Five Regional Health Authorities (RHAs) are responsible for the provision of healthcare services, including oncology care. Given the high BC mortality rates documented in TT, we sought to examine whether differences in BC incidence, mortality and/or survival existed by race/ethnicity or geography.
Methods: This study analyzed the associations among race/ethnicity and geographical residence (based on RHA) and BC incidence and mortality as well as survival of 3777 female BC cases reported between January 1995 and December 2005 to the Dr. Elizabeth Quamina Cancer Registry, which serves as the National Cancer Registry of TT. The population data was based on the census figures for 2000 and 2010 as reported by the Central Statistical Office of Trinidad and Tobago. Chi-square tests were used to examine the associations between race/ethnicity and geographical residence and BC incidence and mortality. Lifetest analyses were used to examine differences in BC survival by race/ethnicity and geographical area of residence.
Results: Overall 22.7% of the cases were diagnosed at age &lt;45 years, 39.5% at 45-60 years and 37.8% at age &gt;60 years. The largest proportion of BC diagnosed at &lt;45 years was observed among women of mixed ancestry, whereas the largest proportion of BCs diagnosed at &gt;60 years was observed among women of African ancestry (p&lt;0.0001). A larger proportion of BC cases diagnosed at localized or regional stage was observed among women of Indian ancestry (p=0.0019). Among women of African and mixed ancestry, North West RHA was the most populous geographic area while among those of Indian ancestry South West RHA was most populous (p&lt;0.001). The highest incidence and mortality rates occurred in regions covered by the North West Regional Health Authority followed by those areas under the governance of the North Central Regional health Authority. Women of African ancestry had higher BC incidence and mortality than those of Indian or Mixed ancestry, regardless of geographic place of residence. Although we observed no significant difference in BC survival by residence within a particular Regional Health Authority, there were notable differences in survival by race/ethnicity. We found a significant difference in survival time by race/ethnicity among BC cases initiating treatment; specifically, compared to women of Indian and mixed ancestry, those of African ancestry experienced the shortest survival (p&lt;0.0001).
Conclusion: These findings demonstrate that in TT, BC incidence and mortality rates differed significantly by race/ethnicity and geographical residence, while BC survival differed by race/ethnicity. These findings highlight the importance of targeted cancer prevention and control efforts to address the observed disparities in BC in TT.
Citation Format: Wayne A. Warner, Yee Lam Lee, Shelina Ramnarine, Simeon Slovacek, Veronica Roach, Matthew Ellis, Adana Llanos. Associations among race/ethnicity, geography, and breast cancer incidence and mortality in Trinidad and Tobago. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B19.