ASPO Abstracts
Impacts of neighborhood characteristics on treatment and outcomes in women with ductal carcinoma in situ of the breast
Category: Cancer Health Disparities, Pre-Malignant Conditions
Conference Year: 2018
Abstract Body:
Purpose To examine the associations of neighborhood characteristics with treatment and outcomes of ductal carcinoma in situ of the breast (DCIS). Methods From the Missouri Cancer Registry, we identified 9,231 women with DCIS diagnosed between 1996 and 2011. A composite index using the 2000 US Census data was developed to assess census tract-level socioeconomic deprivation and the rural- urban commuting area codes were used to define rural census tracts. Odds ratios (ORs) and 95% confidence intervals (95% CI) of treatment were estimated using logistic regression. Hazard ratios (HRs) of DCIS outcomes were estimated using Cox proportional hazards regression. Results Women in the most socioeconomically deprived areas were more likely than those in the least deprived to have mastectomy (OR 1.54, 95% CI 1.34-1.76), no surgery (OR 2.06, 95% CI 1.39-3.07), no radiation therapy post-breast conserving surgery (BCS) (OR 1.66, 95% CI 1.38-2.01), higher risk of ipsilateral breast tumors (HR 1.44, 95% CI 0.97-2.13, Ptrend=0.08), and lower risk of contralateral breast tumors (HR 0.79, 95% CI 0.57-1.09, Ptrend=0.19). Compared with urban women, rural women had significantly higher odds of underutilization of radiation therapy post-BCS (OR 1.39, 95% CI 1.17-1.66), lower risk of ipsilateral breast tumors (OR 0.88, 95% CI 0.60-1.30), and higher risk of contralateral breast tumors (OR 1.17, 95% CI 0.87-1.57). Conclusion While DCIS treatment significantly varied by neighborhood socioeconomic deprivation and rural/urban locations, we did not observe any significant differences in the risks of second breast tumors.
Keywords: Breast cancer; Ductal carcinoma in situ; Rurality; Socioeconomic deprivation; second breast tumors