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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2023

30-09-2023 | Breast Cancer | Breast Oncology

Racial and Ethnic Disparities in Outcomes After Breast-Conserving Therapy and Endocrine Therapy for DCIS: A Post-Hoc Analysis of the NSABP B-35 Randomized Clinical Trial

Authors: Olga Kantor, MD, MS, Tari A. King, MD, Alyssa Jones, MPH, Charity Glass, MD, MPP, Saskia J. Leonard, BS, Esther R. Ogayo, BS, Erica L. Mayer, MD, MPH, Mariana Chavez-MacGregor, MD, MSc, Lisa A. Newman, MD, MPH, Rachel A. Freedman, MD, MPH, Elizabeth A. Mittendorf, MD, PhD, MHCM

Published in: Annals of Surgical Oncology | Issue 13/2023

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Abstract

Background

Racial and ethnic disparities in outcomes after treatment for ductal carcinoma in situ (DCIS) are largely unknown. The objective of this study was to examine breast cancer outcomes by race and ethnicity in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 clinical trial.

Patients and Methods

The NSABP B-35 trial randomized postmenopausal women with hormone receptor-positive DCIS treated with breast-conserving therapy to 5 years of tamoxifen or anastrozole. In total, 3104 women were enrolled between 2003 and 2006. For this analysis, patients without complete self-reported race and ethnicity or with immediate trial dropout were excluded. Kaplan–Meier curves and adjusted Cox-proportional hazards models were used for analyses.

Results

Of the 3061 women included, 2614 (85.4%) were non-Hispanic white (NHW), 255 (8.3%) were non-Hispanic Black (NHB), 95 (3.1%) were Hispanic, and 96 (3.1%) were Asian or Pacific Islander (API). Endocrine therapy assignment and duration were well balanced between racial and ethnic groups. Median follow-up was 9 years; unadjusted Kaplan–Meier curves did not show any racial differences in disease events. Adjusted Cox-proportional hazards models found API (versus NHW) race to be associated with higher local recurrence [hazard ratio (HzR) 2.45, p = 0.035] and NHB race to be associated with higher distant recurrence (HzR 5.03, p = 0.020) and breast cancer mortality (HzR 3.83, p = 0.046).

Conclusions

Despite similar locoregional treatments and standard endocrine therapy in a clinical trial population, racial and ethnic disparities exist in long-term outcomes for hormone-receptor-positive DCIS. These findings suggest that factors outside of access and treatment may impact DCIS outcomes by race and ethnicity.
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Metadata
Title
Racial and Ethnic Disparities in Outcomes After Breast-Conserving Therapy and Endocrine Therapy for DCIS: A Post-Hoc Analysis of the NSABP B-35 Randomized Clinical Trial
Authors
Olga Kantor, MD, MS
Tari A. King, MD
Alyssa Jones, MPH
Charity Glass, MD, MPP
Saskia J. Leonard, BS
Esther R. Ogayo, BS
Erica L. Mayer, MD, MPH
Mariana Chavez-MacGregor, MD, MSc
Lisa A. Newman, MD, MPH
Rachel A. Freedman, MD, MPH
Elizabeth A. Mittendorf, MD, PhD, MHCM
Publication date
30-09-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14344-z

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