Nondisparate Survival of Non-Hispanic Black Women With Breast Cancer Despite Less Favorable Pathology: Effect of Access to and Provision of Care Within a Military Health Care System

Sarah Darmon; Leann A Lovejoy; Craig D Shriver; Kangmin Zhu; Rachel E Ellsworth

doi:10.1089/heq.2022.0128

Nondisparate Survival of Non-Hispanic Black Women With Breast Cancer Despite Less Favorable Pathology: Effect of Access to and Provision of Care Within a Military Health Care System

Health Equity. 2023 Mar 10;7(1):178-184. doi: 10.1089/heq.2022.0128. eCollection 2023.

Authors

Sarah Darmon¹, Leann A Lovejoy², Craig D Shriver^{1

3}, Kangmin Zhu^{1

3

4

5}, Rachel E Ellsworth^{1

5}

Affiliations

¹ Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
² Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, Pennsylvania, USA.
³ Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
⁴ Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
⁵ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.

Abstract

Introduction: Breast cancer mortality rates are 40% higher in non-Hispanic Blacks (NHBs) than in non-Hispanic White (NHWs) in the United States. All women treated within the Murtha Cancer Center at Walter Reed National Military Medical Center (MCC/WRNMMC) have health insurance and are provided multidisciplinary health care. Pathological factors and outcomes of NHBs and NHWs treated within the MCC/WRNMMC were evaluated to determine whether equal-access health care reduces disparate phenotypes and survival between the racial groups.

Methods: Between 2001 and 2018, 368 NHB and 819 NHW women were diagnosed with breast cancer at MCC/WRNMMC. Differences between NHBs and NHWs in epidemiological and pathological characteristics were evaluated. Overall and breast cancer-specific 5- and 10-year survival rates were compared between races.

Results: Compared with NHWs, NHBs were significantly more likely to have a body mass index ≥30 kg/m², to be unmarried, to have tumors of higher grade, later stage, with lymph node metastases, and to be hormone receptor negative (HR^-)/human epidermal growth factor receptor 2 positive (HER2⁺) or triple negative. After adjustment for demographic factors, NHBs remained significantly more likely to have tumors diagnosed at a higher grade and later stage, and to be HR^-/HER2⁺ or triple negative. Neither 5- nor 10-year overall or breast cancer-specific survival differed significantly between the racial groups after adjusting for demographic and pathological variables.

Discussion: Despite having tumors with less favorable pathological characteristics, overall and disease-free survival disparities were not observed for NHBs treated at MCC/WRNMMC. These data suggest that survival disparities of NHBs with breast cancer can be diminished with provision of quality care.

Keywords: Black; breast cancer; disparities; pathology; survival.