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Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA

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Abstract

Importance

Breast cancer (BC) death rates have not improved for American Indian/Alaska Native (AI/AN) women, whereas, it has significantly decreased for non-Hispanic White (White) women.

Objective

Delineate the differences in patient and tumor characteristics among AI/AN and Whites with BC, and its impact on age and stage at diagnosis as well as overall survival (OS).

Methods

Hospital-based, cohort study using the National Cancer Database to identify female AI/AN and Whites diagnosed with BC between the years 2004 and 2016.

Results

BC in 6866 AI/AN (0.3%) and 1,987,324 Whites (99.7%) were studied. The median age at diagnosis was 58 for AI/AN and 62 for Whites. AI BC patients traveled double the distance for treatment, lived in lower median income zip codes, had a higher percentage of uninsured, higher comorbidities, lower percentage of Stage 0/I, larger tumor size, greater number of positive lymph nodes, higher proportion of triple negative and HER2-positive BC than Whites. All the above comparisons were significant, p<0.001. Association between patient/tumor characteristics with age and stage at diagnosis was not significantly different between AI/AN and Whites. Unadjusted OS was worse for AI/AN as compared to Whites (HR=1.07, 95% CI=1.01–1.14, p=0.023). After adjustment of all covariates, OS was not different (HR=1.038, 95%CI=0.902–1.195, p=0.601).

Conclusion

There were significant differences in patient/tumor characteristics among AI/AN and White BC which adversely impacted OS in AI/AN. However, when adjusted for various covariates, the survival was similar, suggesting that the worse survival in AI/AN is mostly the impact of known biological, socio-economic, and environmental determinants of health.

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Data Availability

There is no similar data currently available. Our hope is that future studies can be done to replicate our findings.

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Funding

This work was supported by the Dakota Cancer Collaborative on Translational Activity (DaCCoTA) Clinical Translation Research (CTR) Scholars Program Grant for the study ‘Breast Cancer patterns and behavior in American Indians in the US’ U54GM128729 (Basson), 07/01/19-06/30/21, NIGMS/University of North Dakota.

Author information

Authors and Affiliations

  1. Sanford Roger Maris Cancer Center, Department of Medicine, University of North Dakota, 820 4th Street N, Fargo, ND, 58102, USA

    Anu G. Gaba

  2. Sanford Center for Biobehavioral Research, Fargo, ND, USA

    Li Cao

  3. Sanford Health, Fargo, ND, USA

    Rebecca J. Renfrew

  4. Eli Lilly, Indianapolis, USA

    DeAnn Witte

  5. Sanford Health, Sioux Falls, SD, USA

    Janet M. Wernisch

  6. University of North Dakota, Grand Forks, ND, USA

    Abe E. Sahmoun

  7. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Sanjay Goel

  8. SAB Biotherapeutics, Inc, Sioux Falls, SD, USA

    Kristi A. Egland

  9. Sanford Center for Biobehavioral Research, Fargo, ND, USA

    Ross D. Crosby

Authors
  1. Anu G. Gaba
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Contributions

Concept and Design: Gaba

Acquisition, analysis or interpretation of data: All authors

Drafting of the manuscript: Gaba, Renfrew, Cao

Critical revision of the manuscript for important intellectual content: All authors

Statistical analysis: Cao, Crosby

Obtained funding: Gaba

Administrative, technical, or material support: Gaba, Wernisch, Witte

Supervision: Gaba, Crosby, Egland

Corresponding author

Correspondence to Anu G. Gaba.

Ethics declarations

Ethics approval and consent to participate

Considering the nature of this retrospective study using de-identified patient level data, IRB approval and patient informed consent was not required, as per our IRB policy.

Conflict of interest

Anu G. Gaba has no conflicts of interest and financial disclosures.

Li Cao has no conflicts of interest and no financial disclosures.

Rebecca J. Renfrew has no conflicts of interest and no financial disclosures.

DeAnn Witte has no conflicts of interest and no financial disclosures.

Janet M. Wernisch has no conflicts of interest and no financial disclosures.

Abe E. Sahmoun has no conflicts of interest and no financial disclosures.

Sanjay Goel has no conflicts of interest and no financial disclosures.

Kristi A. Egland has no conflicts of interest and no financial disclosures.

Ross D. Crosby is a paid statistical consultant for Health Outcomes Solutions, Winter Park, Florida.

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Gaba, A.G., Cao, L., Renfrew, R.J. et al. Differences in Breast Cancers Among American Indian/Alaska Native and non-Hispanic Whites in the USA. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01704-4

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  • DOI: https://doi.org/10.1007/s40615-023-01704-4

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