智力或发育障碍与女性乳腺癌治疗：一项基于人群的回顾性队列研究

IF 7.9 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2025-05-27 DOI:10.1016/j.breast.2025.104509

Rebecca L. Hansford , Brooke Wilson , Rebecca Griffiths , Alyson L. Mahar

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引用次数: 0

摘要

被诊断患有乳腺癌的智力或发育障碍（IDD）的成年人比没有IDD的人更容易死亡。患有和不患有IDD的个体之间的乳腺癌治疗差异可能导致生存差异。我们比较了患有和不患有IDD的成年人的乳腺癌治疗情况。方法采用以人群为基础的回顾性队列研究。我们纳入了安大略省（2007-2018）诊断为I-III期乳腺癌的成年女性。使用已建立的算法识别IDD状态。我们在四个不同的队列中，根据分期和治疗资格，使用病因特异性危险模型估计了IDD与手术切除、辅助化疗和放疗之间的关联。未调整和调整的风险比(HR；根据地区、农村、既往癌症、分期和诊断年份进行调整)，报告了95%的置信区间，说明了死亡的竞争性事件。癌症亚型没有调整，因为大约25%的参与者缺少这一信息。探讨年龄、分期及合并症对疗效的影响。结果4个队列分别为100,679人（IDD = 369）、12,526人（IDD = 57）、60,279人（IDD = 167）和7891人（IDD = 22）。与无IDD的患者相比，IDD患者接受手术切除的可能性较小(HR = 0.84；0.76-0.94)，保乳手术(HR = 0.69；0.60-0.80)，辅助化疗(HR = 0.49；0.32-0.74)，辐射(HR = 0.58；0.46 - -0.73)。IDD患者接受乳房切除术的可能性与乳腺癌患者相同(HR = 1.13；0.97 - -1.33)。接受乳房切除术（相互作用p值= 0.03）和保乳手术（相互作用p值= 0.02）时，年龄和IDD之间存在显著的相互作用。结论需要通过研究了解治疗决策、乳腺癌治疗的可及性，并检查提高指南推荐治疗接受度的潜在途径，从而为有针对性地改善护理提供信息。

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Intellectual or developmental disabilities and curative female breast cancer treatment: A population-based retrospective cohort study

Background

Adults with intellectual or developmental disabilities (IDD) diagnosed with breast cancer are more likely to die than those without IDD. Differences in breast cancer treatment among individuals with and without IDD could contribute to survival disparities. We compared breast cancer treatment receipt among adults with and without IDD.

Methods

A population-based retrospective cohort study was conducted using administrative data. We included adult females diagnosed with stage I-III breast cancer in Ontario (2007–2018). IDD status was identified using an established algorithm. We estimated associations between IDD and surgical resection, adjuvant chemotherapy, and radiation using cause-specific hazards models in four distinct cohorts determined by stage and treatment eligibility. Unadjusted and adjusted hazard ratios (HR; adjusted for region, rurality, previous cancer, stage and year of diagnosis) with 95 % confidence intervals are reported, accounting for the competing event of death. Cancer subtype was not adjusted for as about 25 % of participants were missing this information. Effect modification by age, stage and comorbidity was explored.

Results

The four cohorts included 100,679 (IDD = 369), 12,526 (IDD = 57), 60,279 (IDD = 167), and 7891 individuals (IDD = 22), respectively. Relative to those without IDD, people with IDD were less likely to receive surgical resection (HR = 0.84; 0.76–0.94), breast conserving surgery (HR = 0.69; 0.60–0.80), adjuvant chemotherapy (HR = 0.49; 0.32–0.74), and radiation (HR = 0.58; 0.46–0.73). People with IDD were as likely to receive mastectomy (HR = 1.13; 0.97–1.33). Significant interactions by age and IDD were detected for receipt of mastectomy (interaction p-value = 0.03) and breast conserving surgery (interaction p-value = 0.02).

Conclusions

Research to understand treatment decision-making, the accessibility of breast cancer treatment, and to examine potential pathways to improve receipt of guideline-recommended care are needed to inform targeted improvements in care delivery.

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来源期刊

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.