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Age disparities in triple-negative breast cancer treatment and outcomes: An NCDB analysis

  • Lauren M. Drapalik
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
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  • Ashley Estes
    Affiliations
    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH

    Case Western Reserve University School of Medicine, Cleveland, OH
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  • Anuja L. Sarode
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
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  • Lifen Cao
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
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  • Robert R. Shenk
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
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  • Craig M. Jarrett
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
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  • Amanda L. Amin
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
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  • Megan E. Miller
    Correspondence
    Reprint requests: Megan E. Miller, MD, FACS, Assistant Professor, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047.
    Affiliations
    Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH
    Search for articles by this author
Published:August 01, 2022DOI:https://doi.org/10.1016/j.surg.2022.05.026

      Abstract

      Background

      Race, access to care, and molecular features result in outcome disparities in triple-negative breast cancer (TNBC). We sought to determine the role of age in TNBC disparity by hypothesizing that younger patients receive more comprehensive treatment, resulting in survival differences.

      Methods

      The National Cancer Database was used to identify women with unilateral TNBC treated from 2005 through 2017. Patients were stratified by age (≤40, 41–70, >70); demographics, clinical characteristics, and treatment factors were compared. Logistic regression determined factors associated with treatment received. Survival outcomes were analyzed using a stratified log-rank test.

      Results

      Of the 168,715 patients, 16,287 (9.6%) were ≤40 years. Patients ≤40 were significantly more likely to present at higher clinical stage (P < .001) and receive neoadjuvant chemotherapy (NAC, P < .001). Bilateral mastectomy was the most common surgery for patients ≤40 (37%), whereas partial mastectomy was most often used in patients 41 to 70 years old (48%) and those >70 (49%) (P < .001). Patients ≤40 years were significantly more likely to undergo both NAC and mastectomy than those >40 (odds ratio 1.5, both P < .05) despite a greater in-breast tumor response in the youngest patients. Patients treated with mastectomy and axillary lymph node dissection had inferior survival outcomes compared to those treated with partial mastectomy and sentinel lymph node biopsy across all 3 age groups (P < .001).

      Conclusion

      The clinical characteristics of TNBC differ significantly at the extremes of age, likely driving treatment decisions. Although patients ≤40 present with a more advanced disease and appropriately receive NAC, they also undergo more extensive surgery that does not yield a survival benefit. Further research is needed to determine if age disparity is due to oncologic factors or patient and provider preferences.
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