Online Program

Examining social and clinical characteristics of breast cancer among black women in Trinidad and Tobago: Impact of treatment modalities on survival

Sunday, November 3, 2013

Marlene Camacho-Rivera, ScD, MPH, Department of Population Health, North Shore-LIJ Health System, Great Neck, NY
Tricia Kalwar, MD, MPH, Department of Hematology and Oncology, North Shore-LIJ Health System, Lake Success, NY
Camille Ragin, PhD, MPH, Cancer Prevention and Control Program, Fox Chase Cancer Center- Temple University Health, Philadelphia, PA
Veronica Roach, The National Cancer Registry of Trinidad and Tobago, Mount Hope, Trinidad and Tobago
Emanuela Taioli, MD, PhD, Population Health, North Shore LIJ-Hofstra School of Medicine, Great Neck, NY
Background: While studies have shown that Trinidad and Tobago experiences the highest breast cancer mortality in the Caribbean, the effects of traditional clinical characteristics on treatment and survival have not been analyzed. Methods: We analyzed 2,614 incident breast cancer cases diagnosed between 1995 and 2005 and followed until 2009. Multivariate logistic regression models were fit to examine the effects of race/ethnicity, age, socioeconomic status, place of birth, stage, hormone receptor (HR) status and histology on the likelihood of receiving surgery, radiation, or chemotherapy. Differences in overall survival by treatment were assessed using Cox proportional hazards models. Results: Nine percent of women were diagnosed with distant stage; 54% were identified as HR negative. 95% of women undergo treatment, with nearly 65% receiving at least a combination of two therapies. Women of advanced stage or with HR negative tumors were significantly more likely to undergo chemotherapy but experienced poorer survival (hazard ratio 4.30; 95% CI 3.42-5.41; HR negative 1.22; 95% CI 1.05-1.42), regardless of treatment. Carcinoma not otherwise specified cases were significantly less likely to undergo surgery but had better survival outcomes compared to ductal (hazard ratio 0.81; 95% CI 0.67-0.99). Women having undergone surgery alone, a combination of two therapies, or all therapies had prolonged survival compared to those who received no treatment, after adjustment for other clinical characteristics. Discussion: Although treatment strategies are similar to those reported in the US, disparities in survival remain. Future studies should analyze health care institutional factors which may influence timing and quality of treatment.

Learning Areas:

Clinical medicine applied in public health

Learning Objectives:
Describe the distribution of sociodemographic factors (race/ethnicity, age, socioeconomic status and place of birth), tumor characteristics (stage, hormone receptor status and histology), and treatment modalities among a sample of women with breast cancer in Trinidad and Tobago Analyze the effects of sociodemographic characteristics and tumor characteristics on the likelihood of receiving surgery, radiation, or chemotherapy Compare the effects of sociodemographic factors, tumor characteristics, and treatment options on overall survival

Keyword(s): Breast Cancer, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I recently completed my doctoral degree in social epidemiology and am currently a epidemiology postdoctoral fellow. Within my postdoctoral training, I have gained significant experience examining disparities in lung cancer and breast cancer outcomes. I am qualified to serve as an abstract author because I led the statistical analyses on this paper and have conducted additional breast cancer research within Trinidad and Tobago.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.