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Thanks to @itsnot_pink for the suggestion for a #MedTwitter #Tweetorial on this topic. If you’re interested in learning more about this research on #racialdisparities in early stage breast cancer, then read on... >>
#bcsm #WomenWhoCurie @UMichRadOnc @UMRogelCancer @MROQC1 @UMich https://twitter.com/astro_org/status/1272989857611223044
#bcsm #WomenWhoCurie @UMichRadOnc @UMRogelCancer @MROQC1 @UMich https://twitter.com/astro_org/status/1272989857611223044
Racial differences in breast cancer mortality exist. Unfortunately, racial minorities such as black women have higher mortality from breast cancer. Historically, black women w/ breast cancer had lower rates of radiation after lumpectomy as well. Reference: https://pubmed.ncbi.nlm.nih.gov/21190070/
Hypofractionated radiation (HF) for breast cancer is supported by multiple randomized trials & has been shown to be equally efficacious & also more convenient & less costly than conventional radiation (CF). HF is delivered in 3-4 wk vs 5-6 wk for CF.
Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa0906260
Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa0906260
Financial toxicity is an important consideration for every cancer patient, especially racial minority pts. Notably, black breast cancer patients have been shown to unfortunately experience higher rates of financial toxicity than white women.
Reference: https://pubmed.ncbi.nlm.nih.gov/24663041/
Reference: https://pubmed.ncbi.nlm.nih.gov/24663041/
Taking all of this into account, our study was designed to evaluate practice patterns of hypofractionated breast radiation in the state of Michigan to determine if patients w/ different racial backgrounds were being treated with hypofractionated breast radiation at similar rates.
We found that at the individual patient level, there was a significant racial disparity in hypofractionated breast radiation by race, with black & Asian women less likely to receive it than white women (p=0.0411). The difference between black vs white pts was greatest in 2018.
We evaluated potential factors contributing to this disparity. Upon controlling for patient clustering within facilities, black and Asian pts were no longer less likely to receive hypofractionated breast radiation, suggesting that facility variation appears to contribute. 
Additionally, black and Asian patients had higher rates of triple negative breast cancer (TNBC), 18% and 11%, respectively, vs white patients (8%), which may have contributed since TNBC was not well-studied in the earlier randomized trials of hypofractionated breast radiation.
Other factors that may have contributed are differences in body mass index and breast volume between the different racial groups, as well as other social determinants of health #SDoH and less tangible factors such as patient and provider preferences for treatment modalities.
Our main conclusion: in our database of >9600 early stage breast cancer pts, there were racial disparities in hypofractionated breast radiation w/ black & Asian pts less likely to receive it. Facility variation contributed. Ensuring equitable access to high quality care is impt.
The potential impact of our work = provide insights on the existence of this racial disparity in breast hypofractionation, identify contributing factors such as facility variation & TNBC, and continue work to ensure that pts receive guideline-concordant care regardless of race.
Many thanks to the amazing @MROQC1 team and mentors Lori Pierce @ASCOPres, Reshma Jagsi @reshmajagsi, & many others for their outstanding mentorship, support, and guidance on this project. I am humbled and honored to have had the chance to contribute to this work.
#WomenWhoCurie
#WomenWhoCurie
