medwireNews: US research points to disparities in the diagnosis, treatment, and outcomes of breast cancer in people belonging to minority groups with respect to sexual orientation and gender identity.
Compared with cisgender heterosexual women, those from sex and gender minority (SGM) groups experienced delays in diagnosis, declined oncologist-recommended treatments more often, and had a higher rate of recurrence, report the researchers in JAMA Oncology.
“These results suggest disparities in the care of patients from SGM groups and warrant further study to inform interventions,” they write.
For the case–control study, the team identified 92 breast cancer patients from SGM groups treated at a US academic medical center between January 2008 and January 2022, and matched them to 92 cisgender heterosexual women by age (within 5 years), year of diagnosis (within 7 years), tumor stage, estrogen receptor status, and HER2 status.
The SGM patients were aged a median of 49 years and the majority (80%) were cisgender women who have sex with women, while 13% were cisgender bisexual women and 7% were transgender men. There was a higher proportion of non-Hispanic White (78.3 vs 63.0%) and Hispanic (14.1 vs 7.6%) individuals in the SGM than control group, while the proportion of Asian or Pacific Islander patients was lower (3.3 vs 25.0%).
Erik Eckhert (Stanford University School of Medicine, California, USA) and co-researchers found that although the use of guideline-based screening was comparable for the cohorts, patients from SGM groups were significantly more likely to have a delay in diagnosis than cisgender heterosexual patients. The median time to diagnosis was 64 versus 34 days, and multivariable analysis gave a significant hazard ratio for the probability of diagnosis after symptom onset of 0.65 after adjusting for race and ethnicity, socioeconomic status, and private insurance status.
The team found no differences with regard to several aspects of treatment, such as time to first treatment, receipt of lumpectomy versus mastectomy for localized disease, and receipt of adjuvant radiotherapy after lumpectomy. But 38% of patients from SGM groups refused oncologist-recommended anticancer therapies compared with 20% of controls; the between-group difference was significant and equated to an adjusted odds ratio (OR) of 2.27.
Finally, the rate of cancer recurrence was significantly higher among patients from SGM groups than their cisgender heterosexual counterparts, at 32.2% and 13.3%, respectively, and an adjusted OR of 3.07.
“Adjustments for factors that were imbalanced between groups, including race and ethnicity, did not affect these estimates for SGM groups significantly in a sensitivity analysis,” say Eckhert and colleagues.
They believe that “these findings speak to an opportunity to better align the goals and values of patients from SGM groups with those of their oncologists through targeted education and culturally appropriate supportive care programs.”
Eckhert et al add that “health care disparities in breast cancer treatment and outcomes of patients from SGM groups should be evaluated by adding [sexual orientation and gender identity] data to large cancer databases and should also be investigated in prospective population-based studies, both of which have the potential to inform health care interventions aimed at improving the quality of care for SGM patients with breast cancer.”
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