Work

Impact of Socioeconomic Factors on Surgical Approach and Outcomes in Young Women with Breast Cancer

Year: 2025

Type: article

Abstract: Objective: Breast cancer treatment disparities persist and include surgical approach.This study evaluated the association of race, ethnicity, employment, and insurance status with the selected surgical approach and the effect on recurrence-free survival (RFS) and overall survival (OS) in young women with breast cancer. Materials and Methods:A retrospective review of a prospectively maintained institutional database (Sandra Levine Young Women's Breast Cancer Program) identified women aged ≤40 years diagnosed with non-metastatic breast cancer from 2010-2019 who underwent surgery.Multivariable logistic regression models and Cox proportional-hazards models were fitted.Results: Of the 700 women, 4% were Asian, 26% Black, and 69% White.Reported ethnicity was: 67% non-Hispanic, 5% Hispanic, and 27% unknown or unreported.Clinical stage distribution was 86% early stage (0-II) and 11% stage III.Among patients with invasive cancer (n = 624), 51% were hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 21% were HR-negative/HER2-negative, 20% were HR-positive/HER2positive, and 8% were HR-negative/HER2-positive. Local, regional, or distant recurrence occurred in 13.1% of patients who underwent lumpectomy and in 16.4% of those who underwent mastectomy (p = 0.22).Death occurred in 6.5% of patients after lumpectomy and in 10.7% of patients after mastectomy (p = 0.07).Black women were more likely to undergo lumpectomy than White women [odds ratio = 2.26; 95% confidence interval (CI), 1.49-3.43;p<0.001; adjusted for ethnicity].Private insurance was associated with improved OS (hazard ratio = 2.47; 95% CI, 1.26-4.84;p = 0.003) and RFS (hazard ratio = 2.02; 95% CI, 1.28-3.20;p = 0.010) compared with Medicaid.No association was noted between employment status and surgical approach, OS, or RFS.Conclusion: Young Black women were more likely than White women to elect the less-invasive surgery (lumpectomy).Private insurance was associated with better OS and RFS.

Source: European Journal of Breast Health

DOI: 10.4274/ejbh.galenos.2025.2025-8-8