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Patel TA, Dee EC, Jain B, Vapiwala N, Fayanju O, Santos P. Disparities in Breast-Conserving Therapy vs. Mastectomy among Asian American and Pacific Islander Women. Int J Radiat Oncol Biol Phys 2023; 117:e198-e199. [PMID: 37784843 DOI: 10.1016/j.ijrobp.2023.06.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Multiple randomized trials support the use of breast-conserving therapy (BCT), defined as lumpectomy followed by adjuvant radiotherapy, as an alternative to mastectomy for definitive treatment of early-stage (T1-2N0) breast cancer. However, data suggest that Asian American, Native Hawaiian, and Pacific Islander (AANHPI) may undergo mastectomy at higher rates than BCT and may experience barriers to receipt of BCT. The purpose of this study was to examine BCT utilization by disaggregated AANHPI groups to identify differences in receipt of mastectomy versus BCT. MATERIALS/METHODS The 2004-2017 National Cancer Database was queried to identify women age ≥18 years old diagnosed with cT1-2N0M0 breast cancer treated with either BCT or mastectomy without post-mastectomy radiation therapy. Women were classified based on self-reported race. Multivariable logistic regression defined adjusted odds ratios (OR) assessing the association between race and receipt of BCT versus mastectomy for all patients and separately by cT1-2 stage. All models were adjusted for relevant sociodemographic and clinical factors. RESULTS Of 794,403 women with cT1-2N0M0 breast cancer, 239,801 (30%) received mastectomy and 554,602 (70%) received BCT. After adjusting for clinical and sociodemographic factors, AANHPI women had greater odds of receiving mastectomy over BCT, compared to White women (OR [95% CI], 1.35 [1.30-1.39]; p<0.001). In contrast, Black women were less likely than White women to receive mastectomy (0.86 [0.84-0.87]; p<0.001). Upon disaggregation, Chinese, Japanese, Filipino, Korean, Vietnamese, and Asian Indian & Pakistani women were more likely to receive mastectomy over BCT compared to White women (p<0.001 for all). Treatment at academic (1.30 [1.27-1.32]), integrated (1.24 [1.21-1.27]), and comprehensive community cancer centers (1.15 [1.13-1.17]) were all associated with greater odds of mastectomy compared to treatment at community cancer programs (all p<0.001). Greater distance from treatment facility (≥50 mi. vs. 0 to <10 mi. [reference], OR 1.50 [1.47-1.53]) and cT2 disease (1.85 [1.82-1.87]) were also associated with greater odds of receiving mastectomy (all p<0.001). CONCLUSION In this evaluation of women with early-stage breast cancer, women from several AANHPI groups were more likely to receive mastectomy (as opposed to BCT) compared to White women. While sociocultural preferences, differences in access to and interest in reconstruction, as well as prevalent tumor-to-breast ratios may partially explain the disparities, collectively our data suggest an ongoing need for greater patient involvement in shared-decision making, particularly in vulnerable and understudied Asian populations.
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Affiliation(s)
- T A Patel
- University of Pennsylvania, Philadelphia, PA
| | - E C Dee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - B Jain
- Massachusetts Institute of Technology, Cambridge, MA
| | - N Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - O Fayanju
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Santos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Skowron KB, Pitroda SP, Namm JP, Balogun O, Beckett MA, Zenner ML, Fayanju O, Huang X, Fernandez C, Zheng W, Qiao G, Chin R, Kron SJ, Khodarev NN, Posner MC, Steinberg GD, Weichselbaum RR. Basal Tumor Cell Isolation and Patient-Derived Xenograft Engraftment Identify High-Risk Clinical Bladder Cancers. Sci Rep 2016; 6:35854. [PMID: 27775025 PMCID: PMC5075783 DOI: 10.1038/srep35854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/06/2016] [Indexed: 12/25/2022] Open
Abstract
Strategies to identify tumors at highest risk for treatment failure are currently under investigation for patients with bladder cancer. We demonstrate that flow cytometric detection of poorly differentiated basal tumor cells (BTCs), as defined by the co-expression of CD90, CD44 and CD49f, directly from patients with early stage tumors (T1-T2 and N0) and patient-derived xenograft (PDX) engraftment in locally advanced tumors (T3-T4 or N+) predict poor prognosis in patients with bladder cancer. Comparative transcriptomic analysis of bladder tumor cells isolated from PDXs indicates unique patterns of gene expression during bladder tumor cell differentiation. We found cell division cycle 25C (CDC25C) overexpression in poorly differentiated BTCs and determined that CDC25C expression predicts adverse survival independent of standard clinical and pathologic features in bladder cancer patients. Taken together, our findings support the utility of BTCs and bladder cancer PDX models in the discovery of novel molecular targets and predictive biomarkers for personalizing oncology care for patients.
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Affiliation(s)
- K B Skowron
- University of Chicago Medicine, Dept. of Surgery, Chicago, IL, USA
| | - S P Pitroda
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - J P Namm
- University of Chicago Medicine, Dept. of Surgery, Chicago, IL, USA.,Loma Linda University Health, Dept. of Surgery, Loma Linda, CA USA
| | - O Balogun
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - M A Beckett
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - M L Zenner
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL USA
| | - O Fayanju
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA
| | - X Huang
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - C Fernandez
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA.,University of Illinois at Chicago, Chicago, IL USA
| | - W Zheng
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - G Qiao
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - R Chin
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA.,University of California Los Angeles, Dept. of Radiation Oncology, Los Angeles, CA, USA
| | - S J Kron
- University of Chicago, Dept. of Molecular Genetics and Cell Biology, Chicago, IL, USA
| | - N N Khodarev
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
| | - M C Posner
- University of Chicago Medicine, Dept. of Surgery, Chicago, IL, USA
| | - G D Steinberg
- University of Chicago Medicine, Dept. of Surgery, Chicago, IL, USA
| | - R R Weichselbaum
- University of Chicago Medicine, Dept. of Radiation and Cellular Oncology, Chicago, IL, USA.,The Ludwig Center for Metastasis Research, University of Chicago, Chicago, IL, USA
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