ASPO Abstracts
Association of hot spots with de novo metastatic breast cancer survival among African-American women
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020
Abstract Body:
Purpose: Given geographic and racial/ethnic disparities in breast cancer survival rates, we aimed to investigate
the association of geographic breast cancer mortality hot spots (counties with high breast cancer mortality rates)
with de novo metastatic (or metastatic at initial diagnosis) breast cancer mortality among black women.
Methods: We identified 7,292 black women diagnosed with de novo metastatic breast cancer in the Surveillance,
Epidemiology and End Results (SEER)18 registries between 1990 and 2016. The county-level proportions for
race/ethnicity, population with a college education, household income, obesity, smoking, etc., were obtained from
2014 County Health Rankings. We linked county-level characteristics to the SEER data using residence at the
time of diagnosis. We used Cox proportional hazards models to compare breast cancer-specific mortality and all-
cause mortality among black women residing in breast cancer mortality hot spots vs non-hot spot counties.
Results: Among 7,292 black women, 393 (5.39%) women resided in breast cancer mortality hot spots. Women
residing in hot spot counties had a similar risk of breast cancer-specific mortality (adjusted hazard ratio [aHR],
0.99; 95% confidence interval [CI], 0.86 - 1.13) and all-cause mortality (aHR, 0.98; 95% CI, 0.86 - 1.11) as women
in non-hot spot counties after adjusting for age, year of diagnosis, marital status, tumor characters (histology,
grade, hormone receptor status), treatments (surgery, radiation, and chemotherapy), and SEER registries.
Additional adjustment for county-level characteristics did not impact the results of breast cancer-specific mortality
(aHR, 0.97; 95% CI, 0.85 - 1.11) and all-cause mortality (aHR, 0.96; 95% CI, 0.84 - 1.09).
Conclusions: Our findings indicate that living in a breast cancer mortality hot spot does not impact mortality among
black women with de novo breast cancer at diagnosis. Any survival advantage gained from living in a breast
cancer mortality non-hot spot is diminished when you are diagnosed with de novo metastatic breast cancer could
be due to the issues of hot spots (access to care, screening, etc.) are also important predictors of being diagnosed
with de novo metastatic breast cancer.
Keywords: de novo, metastatic breast cancer, black women, survival, breast cancer mortality hot spot