Abstract
South Asian American (SA) women are diagnosed with more aggressive breast cancer than non-Hispanic White (NHW) women. Understanding the factors associated with the types of surgery received by these women sheds light on disease management in these culturally distinct populations. We used data on age at diagnosis, stage, grade, estrogen and progesterone receptors, and surgery from 4,590 SA and 429,030 NHW breast cancer cases in the Surveillance, Epidemiology and End Results (SEER) program. We used logistic regression with surgery as the binary outcome (subcutaneous, total, or radical mastectomy (STRM) versus partial mastectomy, no, unknown or other (PNUM)) and included additive effects of all the variables and interactions of age, stage, grade, and estrogen and progesterone receptors with race/ethnicity. Type I error of 5% was used to assess statistical significance of the effects. SA were significantly more likely than NHW cases to receive STRM relative to PNUM surgery among women diagnosed at or after age 50 years and having localized stage disease (Odds Ratio (OR) = 1.27, 95% Confidence Interval (CI) = 1.06 – 1.52). Further, SA were significantly less likely than NHW cases to receive STRM relative to PNUM surgery among those diagnosed before age 50 years and having regional or distant stage disease (OR = 0.75, 95% CI = 0.59 – 0.95 for age at diagnosis < 40 years; OR = 0.77, 95% CI = 0.62 – 0.95 for age at diagnosis 40–49 years). The type of surgery received by SA and NHW women differ according to age at diagnosis and disease stage.
South Asians (SA) are a fast-growing minority population in the U.S and confront a wide range of chronic disease, including breast cancer. SA women are diagnosed with more aggressive breast cancer than non-Hispanic White (NHW) women, characterized by younger age at diagnosis, regional or distant stage, higher grade, and ER negative tumors. Surgery – especially lumpectomy or mastectomy – is one of the treatments available for breast cancer. In the U.S, lumpectomy is used to treat early-stage breast cancers, while mastectomy is used for later stage breast cancers. In contrast, mastectomy is more commonly used in Asian countries, regardless of disease stage. It is important to understand the type of surgery and the factors that contribute to determining the type of surgery in SA breast cancer cases in the U.S relative to NHW cases. Our analyses reveal differences in the type of surgery received by SA and NHW breast cancer cases, and these differences vary according to age at diagnosis and disease stage. Further research is needed to gain deeper insights into these differences.