Racial Disparities in Pathologic Complete Response and Survival after Neoadjuvant Chemotherapy for Breast Cancer.

Area of Science:

• Oncology
• Health Disparities
• Epidemiology

Background:

• Pathologic complete response (pCR) is a key surrogate endpoint for breast cancer treatment efficacy, particularly in high-risk cases.
• Existing research on racial disparities in pCR yields varied results across different data sources and settings.
• The Surveillance, Epidemiology, and End Results (SEER) Program offers a robust dataset for population-level analysis of breast cancer outcomes.

Purpose of the Study:

• To investigate racial differences in pCR rates between Black and White women undergoing neoadjuvant chemotherapy for nonmetastatic breast cancer.
• To evaluate the impact of race and pCR status on breast cancer-specific and all-cause mortality.
• To identify potential disparities in breast cancer treatment outcomes using real-world data.

Main Methods:

• A population-based cohort study was conducted using the SEER database.
• Inclusion criteria comprised Black and White women diagnosed with nonmetastatic breast cancer who received neoadjuvant chemotherapy between 2010 and 2018.
• Statistical analyses assessed differences in pCR rates and survival outcomes, adjusting for relevant factors.

Main Results:

• Analysis of 10,254 patients revealed lower odds of pCR for Black women compared to White women (adjusted OR, 0.85; 95% CI, 0.76-0.95).
• After a median follow-up of 5.2 years, no significant difference in mortality risk was observed between races among patients who achieved pCR.
• Among patients who did not achieve pCR, Black women exhibited a higher risk of both breast cancer-related and all-cause mortality.

Conclusions:

• Real-world data indicate that Black women have diminished likelihood of achieving pCR and poorer survival outcomes if pCR is not attained.
• The study underscores significant racial disadvantages in breast cancer outcomes outside of clinical trial settings.
• These findings emphasize the urgent need for targeted interventions to ensure equitable treatment and improve survival for all breast cancer patients.