Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study

Unveiling Inequities: Racial Disparities in Risk-Reducing Mastectomy for Breast Cancer Prevention

BACKGROUND

Risk-reducing mastectomy (RRM) significantly lowers breast cancer risk as a preventive surgery. While racial disparities in breast cancer treatment are well-documented, research on racial differences in the utilization and outcomes of RRM is limited.

METHODS

We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program (2008-2022) to identify women who underwent RRM. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes were compared between White and racial minority patients, including Black/African American women.

RESULTS

Among 1,285 patients, 88% (n = 1,126) self-identified as White and 12.4% (n = 159) as racial minorities, including 5.8% (n = 74) Black. Minority patients were younger than White patients (50.7±11.4 years vs. 52.6±12.6 years; P = .66). Black patients had a significantly higher mean BMI than White patients (33.6±8.4 kg/m² vs. 30.6±8.0 kg/m²; P = .03), and higher prevalence of obesity (65%, n = 48 vs. 47%, n = 524; P = .03) and hypertension (51%, n = 38 vs. 30%, n = 342; P = .007). Racial minority patients were more likely to undergo outpatient surgery (81%, n = 129 vs. 57%, n = 645; P < .001) and had shorter hospital stays than White patients (0.8±1.3 days vs. 1±2 days; P = .001). Black patients experienced higher rates of superficial incisional infections (9.5%, n = 7 vs. 2.9%, n = 33; P = .18) and overall complications (18%, n = 13 vs. 10%, n = 113; P = .48) CONCLUSION: This multi-institutional study reveals racial disparities in RRM, with minority patients significantly more likely to present with comorbidities and experience higher complication rates. These findings underscore the need for targeted strategies to ensure equitable access to RRM and improve outcomes for minority patients, advancing health equity in breast cancer prevention.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally, epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer. This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography, ultrasound, magnetic resonance imaging (MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.