Background
Socioeconomic and racial disparities can limit access to health care. ADI is an index that categorizes areas based on socioeconomic variables. Prior studies suggested an association between poor socioeconomic status and mutations linked to poor prognosis such as TP53 mutations in breast cancer (BC). We hypothesized that patients (pts) living in more deprived/disadvantaged areas will have higher percentages of somatic mutations. In this observational study, we aimed to investigate the ADI among pts with BC seen at Roswell Park Comprehensive Cancer Center and study frequency of next generation sequencing testing (NGST) and prevalence of mutations.
Methods
Data from 187 patients diagnosed with stages 1-3 and de-novo stage 4 BC between 2014 to 2018 were collected. We used the Neighborhood Atlas tool www.neighborhoodatlas.medicine.wisc.edu to obtain pts ADI, then we categorized it into four quartiles Q1(80-100%), Q2(60-79%), Q3(40- 59%), Q4(0-39%) from highest deprivation/poor socioeconomic status to least disadvantaged areas, respectively. SAS v9.4 used to run analyses at a significance level of < 0.05.
Results
98% pts were females, 85% Whites, 9% African Americans, and 3% Asians. 62% resided in the most disadvantaged areas: 37% in Q1, 25% in Q2, 27% lived in Q3, and 11% in Q4. 80% pts were diagnosed with hormone receptor positive, 18% HER2 positive, and 15% triple negative BC. There was no difference in the distribution of age, race, comorbidities, smoking, access to oral contraceptives, or undergoing screening mammograms by ADI.
Conclusion
Our study shows 62% of BC pts resided in the most disadvantaged areas. These pts had higher frequency of mutation in TP53 and other tumor suppressor genes (68% [n=21/31] vs. 27% [n=4/15]).Besides socioeconomic factors including access to health care, these adverse biological factors may also contribute to worse outcomes and should be addressed in larger studies.