ARRS 2022 Abstracts

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2034. Breast Cancer Imaging Surveillance and 5-Year Recurrence Outcomes Between a Safety-Net and a Tertiary Care Hospital in the Same District
Authors * Denotes Presenting Author
  1. Zachary Acevedo *; University of Texas Southwestern Medical Center
  2. Ann Mootz; University of Texas Southwestern Medical Center
  3. Nisha Unni; University of Texas Southwestern Medical Center
  4. Chika Nwachukwu; University of Texas Southwestern Medical Center
  5. Basak Dogan; University of Texas Southwestern Medical Center
Objective:
This study aims to compare presenting stage, biomarker, and follow-up patterns following successful treatment of breast cancer at a safety-net hospital (SNH) or a same-district university-affiliated tertiary care center (UH).

Materials and Methods:
We reviewed electronic health records of 645 patients with newly diagnosed breast cancer at SNH and UH between 3/1/2014 and 3/1/2016. We excluded patients who underwent upfront bilateral mastectomy or were lost to follow-up before 6 months (M) post definitive treatment. Patient follow-up imaging was collected for 5-years post definitive treatment. Statistical analysis used Chi-square and Fisher exact tests for dichotomous variables. The Kolmogorov-Smirnov test was used to assess the normality of continuous variables before comparing with a t-test.

Results:
Of the 645 patients, 251 (38.9%) were diagnosed in SNH and 394 (61.1%) in UH. SNH had a significantly higher rate of Stage IV cancers at presentation [SNH 7.6% (19/251) vs. UH 1.8% (7/394), p<0.001], Hispanic patients [SNH 47.1% (80/170) vs. UH 6.5% (16/246), p<0.001] and Black patients [SNH 36.5% (62/170) vs. UH 17.5% (43/246), p<0.001], while UH had more Non-Hispanic White patients [SNH 10.0% (17/170) vs. UH 61.4% (151/246), p<0.001]. Mean patient age at diagnosis was younger at SNH [54.5 years vs. UH 62.4 years, p<0.001]. T3 and T4 cancers [SNH 17.6% (30/170) vs. UH 2.8% (7/246), p<0.001], grade 2 and 3 cancers [SNH 84.1% (143/170) vs. UH 71.8% (176/245), p=0.004], and nodal metastasis (pN0 vs. pN+) [SNH 29.4% (50/170) vs. UH 15.0% (37/246), p<0.001] were higher at SNH, while there was a lower rate of Luminal A cancers [SNH 19.1% (27/141) vs. UH 34.2% (66/193), p=0.002]. Adjusting for patient deaths and bilateral mastectomies, SNH cancers were significantly less likely to undergo imaging follow up at all timepoints (p<0.05). SNH patients were significantly less likely to complete adjuvant chemotherapy [SNH 71.9% (23/32) vs. UH 95.7% (44/46), p=0.006]. The rate of recurrence was higher [SNH 12.4% (21/170) vs. UH 5.7% (14/246), p=0.02] and earlier at SNH (22.1 M vs. UH 33.7 M, p=0.049). Significantly more cancers at SNH were lost to follow up over the study period [SNH 27.6% (47/170) vs. UH 16.3% (40/246), p=0.005]. Of the remaining patients, who completed therapy, death rates [SNH 14.6% (18/123) vs. UH 9.2% (19/206), p=0.13] and time of death (35.8 M SNH vs. 33.7 M UH, p=0.76) were similar.

Conclusion:
Despite having comparable access to healthcare, SNH patients had a higher rate of presenting with biologically unfavorable breast cancers at an advanced stage and were significantly less likely to have follow-up imaging, while also having higher rates of, and earlier, recurrence.