Impact of Socioeconomic Factors on Surgical Approach and Outcomes in Young Women with Breast Cancer.

Objective: Breast cancer treatment disparities persist and include surgical approach. This study evaluated the association of race, ethnicity, employment, and insurance status with the selected surgical approach and the effect on recurrence-free survival (RFS) and overall survival (OS) in young women with breast cancer. Materials and Methods: A retrospective review of a prospectively maintained institutional database (Sandra Levine Young Women's Breast Cancer Program) identified women aged ≤40 years diagnosed with non-metastatic breast cancer from 2010-2019 who underwent surgery. Multivariable logistic regression models and Cox proportional-hazards models were fitted. Results: Of the 700 women, 4% were Asian, 26% Black, and 69% White. Reported ethnicity was: 67% non-Hispanic, 5% Hispanic, and 27% unknown or unreported. Clinical stage distribution was 86% early stage (0-II) and 11% stage III. Among patients with invasive cancer (n = 624), 51% were hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative, 21% were HR-negative/HER2-negative, 20% were HR-positive/HER2-positive, and 8% were HR-negative/HER2-positive. Local, regional, or distant recurrence occurred in 13.1% of patients who underwent lumpectomy and in 16.4% of those who underwent mastectomy (p = 0.22). Death occurred in 6.5% of patients after lumpectomy and in 10.7% of patients after mastectomy (p = 0.07). Black women were more likely to undergo lumpectomy than White women [odds ratio = 2.26; 95% confidence interval (CI), 1.49-3.43; p<0.001; adjusted for ethnicity]. Private insurance was associated with improved OS (hazard ratio = 2.47; 95% CI, 1.26-4.84; p = 0.003) and RFS (hazard ratio = 2.02; 95% CI, 1.28-3.20; p = 0.010) compared with Medicaid. No association was noted between employment status and surgical approach, OS, or RFS. Conclusion: Young Black women were more likely than White women to elect the less-invasive surgery (lumpectomy). Private insurance was associated with better OS and RFS.