scholarly journals Racial Disparities in Cancer Presentation and Outcomes: The Contribution of Overdiagnosis

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Andrea R Marcadis ◽  
Louise Davies ◽  
Jennifer L Marti ◽  
Luc G T Morris
Keyword(s):  
Breast Cancer ◽  
Thyroid Cancer ◽  
Black Women ◽  
Racial Disparities ◽  
Papillary Thyroid Cancer ◽  
White Women ◽  
Statistical Tests ◽  
Papillary Thyroid ◽  
Advanced Tumor ◽  
Black Populations

Abstract Background Racial disparities in cancer have been attributed to population differences in access to care. Differences in cancer overdiagnosis rates are another, less commonly considered cause of disparities. Here, we examine the contribution of overdiagnosis to observed racial disparities in papillary thyroid cancer and estrogen/progesterone receptor positive (ER/PR+) breast cancer. Methods We used Surveillance, Epidemiology, End-Results (SEER) 13 for analysis of white and black non-Hispanic persons with papillary thyroid cancer or ER/PR+ breast cancer (1992–2014). Analyses were performed using SeerStat (v8.3.5, March 2018). All statistical tests were two-sided. Results White persons had higher incidence of papillary thyroid cancer than black persons (14.3 vs 7.7 cases per 100 000 age-adjusted population) and ER/PR+ breast cancer (94.8 vs 70.9 cases per 100 000 age-adjusted population) (P < .001). In papillary thyroid cancer, the entire incidence difference was from more frequent diagnosis of 2-cm or less (10.0 vs 4.9 cases per 100 000 population) and localized or regional (13.8 vs 7.4 cases per 100 000 population) cancers in white persons (P < .001), without corresponding excess of metastatic disease, cancers greater than 4 cm, or incidence-based mortality in black persons. In women with ER/PR+ breast cancer, 95% of the incidence difference was from more 2-cm or less (61.2 vs 38.1 cases per 100 000 population) or 2.1- to 5-cm (25.4 vs 23.4 cases per 100 000 population), localized (65.1 vs 43.0 cases per 100 000 population) cancers diagnosed in white women (P < .001), with slightly higher incidence of tumors greater than 5 cm (10.1 vs 9.3 cases per 100 000 population, P < .001) and incidence-based mortality (8.1 vs 7.2 cases per 100 000 population, P < .001) among black women. Overall, 20–30 additional small or localized ER/PR+ breast cancers were diagnosed in white compared with black women for every large or advanced tumor avoided by early detection. Overdiagnosis was estimated 1.3–2.5 times (papillary thyroid cancer) and 1.7–5.7 times (ER/PR+ breast cancer) higher in white compared with black populations. Conclusions Differences in low-risk cancer identification among populations lead to overestimation of racial disparities. Estimates of overdiagnosed cases should be considered to improve care and eliminate disparities while minimizing harms of overdiagnosis.

Distant metastases after diagnosis: Racial disparities in breast cancer outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1084-1084
Author(s):  
Julia Blanter ◽  
Ilana Ramer ◽  
Justina Ray ◽  
Emily J. Gallagher ◽  
Nina A. Bickell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Black Women ◽  
Racial Disparities ◽  
Late Stage ◽  
White Women ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Stage At Diagnosis

1084 Background: Black women diagnosed with breast cancer are more likely to have a poor prognosis, regardless of breast cancer subtype. Despite having a lower incidence rate of breast cancer when compared to white women, black women have the highest breast cancer death rate of all racial and ethnic groups, a characteristic often attributed to late stage at diagnosis. Distant metastases are considered the leading cause of death from breast cancer. We performed a follow up study of women with breast cancer in the Mount Sinai Health System (MSHS) to determine differences in distant metastases rates among black versus white women. Methods: Women were initially recruited as part of an NIH funded cross-sectional study from 2013-2020 to examine the link between insulin resistance (IR) and breast cancer prognosis. Women self-identified as black or white race. Data was collected via retrospective analysis of electronic medical records (EMR) between September 2020-January 2021. Distant metastases at diagnosis was defined as evidence of metastases in a secondary organ (not lymph node). Stage at diagnosis was recorded for all patients. Distant metastases after diagnosis was defined as evidence of metastases at any time after initiation of treatment. Univariate analysis was performed using Fisher’s exact test, multivariate analysis was performed by binary logistic regression, and results expressed as odds ratio (OR) and 95% confidence interval (CI). A p value <0.05 was considered statistically significant. Results: We identified 441 women enrolled in the IR study within the MSHS (340 white women, 101 black women). Median follow up time for all women was 2.95 years (median = 3.12 years for white and 2.51 years for black women (p=0.017)). Among these patients, 11 developed distant metastases after diagnosis: 4 (1.2%) white and 7 (6.9%) black (p=0.004). Multivariate analysis adjusting for age, race and stage at diagnosis revealed that black women were more likely to have distant metastasis (OR 5.8, CI 1.3-25.2), as were younger women (OR for age (years) 0.9, CI 0.9-1.0), and those with more advanced stage at diagnosis. Conclusions: Black women demonstrated a far higher percentage of distant metastases after diagnosis even when accounting for age and stage. These findings suggest that racial disparities still exist in the development of distant metastases, independent from a late-stage diagnosis. The source of existing disparities needs to be further understood and may be found in surveillance, treatment differences, or follow up.

TREM1 fosters an immunosuppressive tumor microenvironment in papillary thyroid cancer

2021 ◽  
Author(s):  
Yang Zhao ◽  
Cangang Zhang ◽  
Yanan Zhu ◽  
Xi Ding ◽  
Yikun Zhou ◽  
...  
Keyword(s):  
T Cells ◽  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Molecular Mechanisms ◽  
Methylation Status ◽  
Disease Free Survival ◽  
Papillary Thyroid ◽  
Advanced Tumor ◽  
Tumor Stages ◽  
Immunosuppressive Microenvironment

The immunosuppressive microenvironment is associated with poor prognosis in papillary thyroid cancer (PTC); however, the molecular mechanisms involved are unknown. Among triggering receptor expressed on myeloid cell (TREM) family, we found that TREM1 expression in PTC was significantly higher than that in normal tissues. TREM1 overexpression was associated with BRAFV600E profiles and advanced tumor stages. Furthermore, TREM1 mRNA expression was negatively correlated with promoter methylation status. Specifically, hypomethylation of CpG site cg06196379 in the TREM1 promoter was related with poor patient disease free survival (DFS) and a high PTC recurrence rate. Mechanistically, TREM1 was mainly expressed in malignant epithelial cells but not macrophages in PTC by single-cell analysis. PTC tissues with high TREM1 levels had enhanced infiltration of regulatory T cells (Tregs) and decreased infiltration of CD8+ T cells. Our study confirms that hypomethylation-mediated overexpression of TREM1 in PTC cells promotes an immunosuppressive microenvironment by enhancing Treg infiltration. We recommend the future use of therapeutic strategy targeting TREM1 for the treatment of PTC.

scholarly journals Health Care Segregation, Physician Recommendation, and Racial Disparities in BRCA1/2 Testing Among Women With Breast Cancer

2016 ◽  
Vol 34 (22) ◽  
pp. 2610-2618 ◽  
Author(s):  
Anne Marie McCarthy ◽  
Mirar Bristol ◽  
Susan M. Domchek ◽  
Peter W. Groeneveld ◽  
Younji Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Disparities ◽  
Racial Differences ◽  
White Women ◽  
Physician Recommendation ◽  
Study Objective ◽  
Black And White ◽  
Physician Characteristics ◽  
White Patients

Purpose Racial disparities in BRCA1/2 testing have been documented, but causes of these disparities are poorly understood. The study objective was to investigate whether the distribution of black and white patients across cancer providers contributes to disparities in BRCA1/2 testing. Patients and Methods We conducted a population-based study of women in Pennsylvania and Florida who were 18 to 64 years old and diagnosed with invasive breast cancer between 2007 and 2009, linking cancer registry data, the American Medical Association Physician Masterfile, and patient and physician surveys. The study included 3,016 women (69% white, 31% black), 808 medical oncologists, and 732 surgeons. Results Black women were less likely to undergo BRCA1/2 testing than white women (odds ratio [OR], 0.40; 95% CI, 0.34 to 0.48; P < .001). This difference was attenuated but not eliminated by adjustment for mutation risk, clinical factors, sociodemographic characteristics, and attitudes about testing (OR, 0.66; 95% CI, 0.53 to 0.81; P < .001). The care of black and white women was highly segregated across surgeons and oncologists (index of dissimilarity 64.1 and 61.9, respectively), but adjusting for clustering within physician or physician characteristics did not change the size of the testing disparity. Black women were less likely to report that they had received physician recommendation for BRCA1/2 testing even after adjusting for mutation risk (OR, 0.66; 95% CI, 0.54 to 0.82; P < .001). Adjusting for physician recommendation further attenuated the testing disparity (OR, 0.76; 95% CI, 0.57 to 1.02; P = .06). Conclusion Although black and white patients with breast cancer tend to see different surgeons and oncologists, this distribution does not contribute to disparities in BRCA1/2 testing. Instead, residual racial differences in testing after accounting for patient and physician characteristics are largely attributable to differences in physician recommendations. Efforts to address these disparities should focus on ensuring equity in testing recommendations.

Assessment of surveillance versus etiologic factors in the reciprocal association between papillary thyroid cancer and breast cancer

2021 ◽  
Vol 74 ◽  
pp. 101985
Author(s):  
Pragati G. Advani ◽  
Lindsay M. Morton ◽  
Cari M. Kitahara ◽  
Amy Berrington de Gonzalez ◽  
Cody Ramin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Papillary Thyroid

scholarly journals Long intergenic non-coding RNA 271 is predictive of a poorer prognosis of papillary thyroid cancer

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Ben Ma ◽  
Tian Liao ◽  
Duo Wen ◽  
Chuanpeng Dong ◽  
Li Zhou ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Signaling Pathway ◽  
Papillary Thyroid Cancer ◽  
Enrichment Analysis ◽  
Disease Status ◽  
Gene Set Enrichment Analysis ◽  
The Cancer Genome Atlas ◽  
Advanced Tumor Stage ◽  
Papillary Thyroid ◽  
Advanced Tumor

Abstract A number of long non-coding RNAs (lncRNAs) have been found to play critical roles in oncogenesis and tumor progression. We aimed to investigate whether lncRNAs could act as prognostic biomarkers for papillary thyroid cancer (PTC) that may assist us in evaluating disease status and prognosis for patients. We found 220 lncRNAs with expression alteration from the annotated 2773 lncRNAs approved by the HUGO gene nomenclature committee in The Cancer Genome Atlas (TCGA) dataset, of which FAM41C, CTBP1-AS2, LINC00271, HAR1A, LINC00310 and HAS2-AS1 were associated with recurrence. After adjusting classical clinicopathogical factors and BRAF V600E mutation, LINC00271 was found to be an independent risk factor for extrathyroidal extension, lymph node metastasis, advanced tumor stage III/IV and recurrence in multivariate analyses. Additionally, LINC00271 expression was significantly downregulated in PTCs versus adjacent normal tissues (P < 0.001). The Gene Set Enrichment Analysis (GSEA) revealed that genes associated with cell adhesion molecules, cell cycle, P53 signaling pathway and JAK/STAT signaling pathway were remarkably enriched in lower-LINC00271 versus higher-LINC00271 tumors. In conclusion, LINC00271 was identified as a possible suppressor gene in PTC in our study, and it may serve as a potential predictor of poor prognoses in PTC.

scholarly journals Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among breast cancer patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 292-292
Author(s):  
Devon Check ◽  
Katherine Elizabeth Reeder-Hayes ◽  
Ethan M. Basch ◽  
Leah L. Zullig ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Racial Disparities ◽  
Cancer Patients ◽  
White Women ◽  
Medicare Part D ◽  
Nausea And Vomiting ◽  
Medicare Part ◽  
Nk1 Receptor ◽  
Part D

292 Background: Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, it can have serious implications for patients’ treatment outcomes, including quality of life. Guidelines recommend the use of an NK1 receptor antagonist to prevent CINV among patients beginning chemotherapy with a high risk of causing the side effect. However, barriers to use of oral NK1s (i.e., aprepitant) exist. In many cases, patients are required to fill a prescription for aprepitant at their home pharmacy. As well, the drug is expensive, costing over $500 under Medicare Part D, and patients may be responsible for a large portion of that cost. These barriers may contribute to racial disparities as they disproportionately affect minority patients. Methods: We used 2006-2012 SEER-Medicare data to evaluate the use of NK1s among black and white women initiating adjuvant chemotherapy with an anthracylcline and cyclophosphamide for early-stage breast cancer. NK1 use during the first chemotherapy cycle was measured using Medicare Part D and Part B claims. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results: Of 1,015 eligible women (911 white; 104 black), 38% of white and 28% of black women received any NK1 at the start of their chemotherapy regimen. In adjusted analyses, black women were 30% less likely than white women to receive any NK1 (aRR black vs. white: 0.70, 95% CI: 0.52-0.94). This disparity was driven by a 44% gap in orally administered NK1s (aprepitant) (aRR: 0.56 95% CI: 0.35-0.89). We did not observe disparities in intravenous fosaprepitant use (aRR: 0.77, 95% CI: 0.46-1.28, NS). After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. Conclusions: Our study found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in women’s ability to afford the medication.

Socioeconomic and racial disparities in the selection and outcomes of a chest-wall boost in post-mastectomy radiation therapy.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 14-14
Author(s):  
Clayton Burnett Hess ◽  
Kari Fish ◽  
Megan Eileen Daly ◽  
Jyoti Mayadev
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Black Women ◽  
Racial Disparities ◽  
Chest Wall ◽  
White Women ◽  
Low Ses ◽  
Advanced Stage ◽  
Lower Stage ◽  
The Impact

14 Background: We investigated socioeconomic and racial disparities in the selection and outcomes of patients from the California Cancer Registry receiving post-mastectomy radiation therapy (PMRT) with or without a chest-wall boost (CWB). Methods: Records of 5,586 women with invasive breast cancer, diagnosed from 2005-2009, treated with PMRT were reviewed and stratified based on treatment with (n=2,482 [44%]) or without (n=3,104 [56%]) a CWB. Race and socioeconomic status (SES) between the cohorts were analyzed. Bivariate analyses of the impact of race and socio-demographic factors on breast cancer-specific survival (BCS) and overall survival (OS) were performed using the Kaplan-Meier method. Adjusting for potential confounders, we used multivariate proportional hazards models to identify predictors of BCS and OS, reported as hazard ratios (HR) with 95% confidence intervals (CI). Results: The majority of PMRT patients were white (58%), compared to Hispanic (20%), Asian/Pacific-Islander (15%), and black (6%). Most were of high SES (50%), compared to middle (21%) or low (29%). Non-white patients were more frequently of low SES (59% vs. 40%). Hispanic frequency (61%) of advanced-stage (3-4) disease was the highest of all races. Low SES was also associated with higher stage (37% vs. 60%) compared to high SES, which comparatively presented with lower-stage (1-2) disease (42% vs. 57%, p=0.0187). Low-SES patients were more likely to receive a CWB (31 vs. 26%) while high-SES patients were less likely (48% vs. 53%, p<0.0001). White women were more likely to be treated without a CWB (60 vs. 57%), while Hispanic women were less likely (23% vs. 18%, p=0.0003). Women not treated with a CWB with low SES had a lower BCS (HR 1.541 p=0.0114) and OS (HR 1.794. p=<0.001) compared to women of high SES. Black women not treated a CWB had lower OS (HR 1.712, p=0.0249) compared to similarly-treated white women. Conclusions: Low SES and Hispanic race were associated with advanced stage, and more commonly treated with a CWB. Low-SES and black women treated without a CWB had lower OS, while the former also had lower BCS. These findings suggest that economic and racial health-care disparities contribute to worse outcomes.

scholarly journals A Recurrent Episode of Dermatomyositis Associated with Papillary Thyroid Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-2
Author(s):  
Vijay Gopal Eranki
Keyword(s):  
Breast Cancer ◽  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Laboratory Data ◽  
Recurrent Episode ◽  
Prior History ◽  
Papillary Thyroid ◽  
Gradual Improvement ◽  
Extensive Evaluation ◽  
History Of

Objective. It is uncommon for dermatomyositis to be associated with papillary thyroid cancer. We report an unusual case of papillary thyroid cancer presenting with dermatomyositis. Methods. The case history, imaging and laboratory data is reviewed. Results. We report the case of a 62-year-old female with a prior history of dermatomyositis and breast cancer who presented with a recurrent episode of dermatomyositis. Extensive evaluation of the cause of the dermatomyositis recurrence revealed no recurrence of the breast cancer but a thyroid nodule was identified. The nodule was biopsied and the patient was noted to have papillary thyroid cancer. The patient subsequently underwent total thyroidectomy and had gradual improvement in her dermatomyositis. Conclusion. It is very uncommon for dermatomyositis to be associated with papillary thyroid cancer.

Sign in / Sign up

Export Citation Format

Share Document