Socioeconomic status impacts tumor biology, treatment, and outcomes in over 200,000 patients with invasive lobular carcinoma of the breast: an analysis of the National Cancer Database.

Abstract

Purpose: While the impact of socioeconomic factors on breast cancer diagnosis, treatment, and outcomes are well-documented, few studies have focused on invasive lobular carcinoma (ILC), the second most common type of breast cancer. We evaluated the relationships between race and socioeconomic status (SES) with clinicopathological characteristics and outcomes in patients with stage I-III ILC using the National Cancer Database (NCDB).

Methods: We used the NCDB, a national oncology database, to evaluate insurance status, a composite measure of SES (education and income), clinicopathological characteristics, and outcomes in patients with stage I-III ILC. Clinicopathologic variables included tumor size, presence of lymphovascular invasion (LVI), and tumor receptor subtype (hormone receptor, HR), and tumor grade. Overall survival was analyzed with multivariable Cox proportional hazards models.

Results: We identified 269,657 patients with stage I-III ILC. Patients in the Medicaid/no insurance group and those with lower SES had larger tumors, more positive lymph nodes, fewer HR+ tumors, and higher-grade tumors. Those in the low SES group had higher rates of chemotherapy use and, in those with HR+ tumors, lower rates of endocrine therapy use. In a multivariable model adjusting for SES, self-identified race/ethnicity, age, stage, receptor subtype, grade, treatment, and Charlson-Deyo score, patients with low SES had a 24% higher risk of death by 5 years compared to patients with high SES (HR 1.24, 95% CI 1.19-1.30, p < 0.001).

Conclusion: While our study confirms several known disparities in the presentation, outcomes, and treatment of breast cancer, this is the first evaluation to assess how different components of SES influence ILC specifically.