PDF(Pubmed)
Abstract：
UNASSIGNED: Disproportionately aggressive tumor biology among non-Hispanic Black women with early-stage, estrogen receptor (ER)-positive breast cancer contributes to racial disparities in breast cancer mortality. It is unclear whether socioecologic factors underlie racial differences in breast tumor biology.
UNASSIGNED: To examine individual-level (insurance status) and contextual (area-level socioeconomic position and rural or urban residence) factors as possible mediators of racial and ethnic differences in the prevalence of ER-positive breast tumors with aggressive biology, as indicated by a high-risk gene expression profile.
UNASSIGNED: This retrospective cohort study included women 18 years or older diagnosed with stage I to II, ER-positive breast cancer between January 1, 2007, and December 31, 2015. All data analyses were conducted between December 2022 and April 2023.
UNASSIGNED: The primary outcome was the likelihood of a high-risk recurrence score (RS) (≥26) on the Oncotype DX 21-gene breast tumor prognostic genomic biomarker.
UNASSIGNED: Among 69 139 women (mean [SD] age, 57.7 [10.5] years; 6310 Hispanic [9.1%], 274 non-Hispanic American Indian and Alaskan Native [0.4%], 6017 non-Hispanic Asian and Pacific Islander [8.7%], 5380 non-Hispanic Black [7.8%], and 51 158 non-Hispanic White [74.0%]) included in our analysis, non-Hispanic Black (odds ratio [OR], 1.33; 95% CI, 1.23-1.43) and non-Hispanic American Indian and Alaska Native women (OR, 1.38; 95% CI, 1.01-1.86) had greater likelihood of a high-risk RS compared with non-Hispanic White women. There were no significant differences among other racial and ethnic groups. Compared with non-Hispanic White patients, there were greater odds of a high-risk RS for non-Hispanic Black women residing in urban areas (OR, 1.35; 95% CI, 1.24-1.46), but not among rural residents (OR, 1.05; 95% CI, 0.77-1.41). Mediation analysis demonstrated that lack of insurance, county-level disadvantage, and urban vs rural residence partially explained the greater odds of a high-risk RS among non-Hispanic Black women (proportion mediated, 17%; P < .001).
UNASSIGNED: The findings of this cohort study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive ER-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.
UNASSIGNED: To examine individual-level (insurance status) and contextual (area-level socioeconomic position and rural or urban residence) factors as possible mediators of racial and ethnic differences in the prevalence of ER-positive breast tumors with aggressive biology, as indicated by a high-risk gene expression profile.
UNASSIGNED: This retrospective cohort study included women 18 years or older diagnosed with stage I to II, ER-positive breast cancer between January 1, 2007, and December 31, 2015. All data analyses were conducted between December 2022 and April 2023.
UNASSIGNED: The primary outcome was the likelihood of a high-risk recurrence score (RS) (≥26) on the Oncotype DX 21-gene breast tumor prognostic genomic biomarker.
UNASSIGNED: Among 69 139 women (mean [SD] age, 57.7 [10.5] years; 6310 Hispanic [9.1%], 274 non-Hispanic American Indian and Alaskan Native [0.4%], 6017 non-Hispanic Asian and Pacific Islander [8.7%], 5380 non-Hispanic Black [7.8%], and 51 158 non-Hispanic White [74.0%]) included in our analysis, non-Hispanic Black (odds ratio [OR], 1.33; 95% CI, 1.23-1.43) and non-Hispanic American Indian and Alaska Native women (OR, 1.38; 95% CI, 1.01-1.86) had greater likelihood of a high-risk RS compared with non-Hispanic White women. There were no significant differences among other racial and ethnic groups. Compared with non-Hispanic White patients, there were greater odds of a high-risk RS for non-Hispanic Black women residing in urban areas (OR, 1.35; 95% CI, 1.24-1.46), but not among rural residents (OR, 1.05; 95% CI, 0.77-1.41). Mediation analysis demonstrated that lack of insurance, county-level disadvantage, and urban vs rural residence partially explained the greater odds of a high-risk RS among non-Hispanic Black women (proportion mediated, 17%; P < .001).
UNASSIGNED: The findings of this cohort study suggest that the consequences of structural racism extend beyond inequities in health care to drive disparities in breast cancer outcome. Additional research is needed with more comprehensive social and environmental measures to better understand the influence of social determinants on aggressive ER-positive tumor biology among racial and ethnic minoritized women from disadvantaged and historically marginalized communities.
摘要：
■非西班牙裔黑人女性早期的不成比例的侵袭性肿瘤生物学，雌激素受体(ER)阳性乳腺癌导致乳腺癌死亡率的种族差异.尚不清楚社会生态因素是否构成乳腺肿瘤生物学中种族差异的基础。
■为了检查个体水平（保险状况）和背景（地区水平的社会经济地位和农村或城市居住）因素，作为ER阳性的患病率中种族和民族差异的可能中介生物学，如高风险基因表达谱所示。
这项回顾性队列研究包括18岁或以上被诊断为I至II期的女性，2007年1月1日至2015年12月31日之间的ER阳性乳腺癌。所有数据分析均在2022年12月至2023年4月之间进行。
■主要结果是在OncotypeDX21基因乳腺肿瘤预后基因组生物标志物上出现高危复发评分(RS)(≥26)的可能性。
■在69139名女性中（平均[SD]年龄，57.7[10.5]年；6310西班牙裔[9.1%]，274名非西班牙裔美国印第安人和阿拉斯加原住民[0.4%]，6017非西班牙裔亚洲及太平洋岛民[8.7%]，5380非西班牙裔黑人[7.8%]，和51158非西班牙裔白人[74.0%])包括在我们的分析中，非西班牙裔黑人(赔率比[OR]，1.33；95%CI，1.23-1.43)和非西班牙裔美国印第安人和阿拉斯加土著妇女(OR，1.38;95％CI，1.01-1.86）与非西班牙裔白人女性相比，发生高风险RS的可能性更大。其他种族和民族之间没有显着差异。与非西班牙裔白人患者相比，居住在城市地区的非西班牙裔黑人女性出现高风险RS的可能性更大(或，1.35；95%CI，1.24-1.46），但不是在农村居民中(或者，1.05；95%CI，0.77-1.41）。中介分析表明，缺乏保险，县级劣势，和城市与农村居住地部分解释了非西班牙裔黑人女性中高风险RS的更大几率(比例介导，17%；P<.001）。
这项队列研究的结果表明，结构性种族主义的后果超出了医疗保健中的不平等，从而导致了乳腺癌结局的差异。需要采取更全面的社会和环境措施进行更多研究，以更好地了解社会决定因素对弱势和历史边缘化社区的种族和族裔少数族裔妇女中积极的ER阳性肿瘤生物学的影响。
■为了检查个体水平（保险状况）和背景（地区水平的社会经济地位和农村或城市居住）因素，作为ER阳性的患病率中种族和民族差异的可能中介生物学，如高风险基因表达谱所示。
这项回顾性队列研究包括18岁或以上被诊断为I至II期的女性，2007年1月1日至2015年12月31日之间的ER阳性乳腺癌。所有数据分析均在2022年12月至2023年4月之间进行。
■主要结果是在OncotypeDX21基因乳腺肿瘤预后基因组生物标志物上出现高危复发评分(RS)(≥26)的可能性。
■在69139名女性中（平均[SD]年龄，57.7[10.5]年；6310西班牙裔[9.1%]，274名非西班牙裔美国印第安人和阿拉斯加原住民[0.4%]，6017非西班牙裔亚洲及太平洋岛民[8.7%]，5380非西班牙裔黑人[7.8%]，和51158非西班牙裔白人[74.0%])包括在我们的分析中，非西班牙裔黑人(赔率比[OR]，1.33；95%CI，1.23-1.43)和非西班牙裔美国印第安人和阿拉斯加土著妇女(OR，1.38;95％CI，1.01-1.86）与非西班牙裔白人女性相比，发生高风险RS的可能性更大。其他种族和民族之间没有显着差异。与非西班牙裔白人患者相比，居住在城市地区的非西班牙裔黑人女性出现高风险RS的可能性更大(或，1.35；95%CI，1.24-1.46），但不是在农村居民中(或者，1.05；95%CI，0.77-1.41）。中介分析表明，缺乏保险，县级劣势，和城市与农村居住地部分解释了非西班牙裔黑人女性中高风险RS的更大几率(比例介导，17%；P<.001）。
这项队列研究的结果表明，结构性种族主义的后果超出了医疗保健中的不平等，从而导致了乳腺癌结局的差异。需要采取更全面的社会和环境措施进行更多研究，以更好地了解社会决定因素对弱势和历史边缘化社区的种族和族裔少数族裔妇女中积极的ER阳性肿瘤生物学的影响。
