TY - JOUR
T1 - Presentation, treatment, and outcomes of haitian women with breast cancer in miami and haiti
T2 - Disparities in breast cancer—a retrospective cohort study
AU - Gomez, Alexandra
AU - Degennaro, Vincent
AU - George, Sophia H.L.
AU - Reis, Isildinha M.
AU - Santamaria, Estefania
AU - Westin, Gustavo Figueiredo
AU - Gabriel, Dieudina
AU - Hurley, Judith
N1 - Funding Information:
Supported by a grant from Susan G. Komen for the Cure and funded in part by Gatorade Trust, Department of Medicine, University of Florida College of Medicine and Innovating Health International. Presented in part at the 8th Annual American Association for Cancer Research Conference of the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, Atlanta, GA, November 13-15, 2015. Corresponding author: Judith Hurley, MD, Division of Hematology and Oncology, University of Miami/Jackson Memorial Hospital, 1550 NW 10th Ave, Fox 300, Miami, FL 33136, e-mail: jhurley@miami.edu.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Purpose We compared a cohort of Haitian immigrants with residents in Haiti with breast cancer (BC) to evaluate the effects of location on presentation, treatment, and outcomes. Patients and Methods Participants were Haitian women with BC living in Miami who presented to the University of Miami/Jackson Memorial Hospital and women with BC living in Haiti who presented to the Innovating Health International Women’s Cancer Center. The primary outcome was the relationship between location, cancer characteristics, and survival. The secondary objective was to compare our results with data extracted from the SEER database. Cox regression was used to compare survival. Results One hundred two patients from University of Miami/Jackson Memorial Hospital and 94 patients from Innovating Health International were included. The patients in Haiti, compared with the patients in Miami, were younger (mean age, 50.2 v 53.7 years, respectively; P = .042), presented after a longer duration of symptoms (median, 20 v 3 months, respectively; P < .001), had more advanced stage (44.7% v 25.5% with stage III and 27.6% v 18.6% with stage IV BC, respectively), and had more estrogen receptor (ER) –negative tumors (44.9% v 26.5%, respectively; P = .024). The percentage of women who died was 31.9% in Haiti died compared with 17.6% in Miami. Median survival time was 53.7 months for women in Haiti and was not reached in Miami. The risk of death was higher for women in Haiti versus women in Miami (adjusted hazard ratio, 3.09; P = .0024). Conclusion Women with BC in Haiti experience a significantly worse outcome than immigrants in Miami, which seems to be related to a more advanced stage and younger age at diagnosis, more ER-negative tumors, and lack of timely effective treatments. The differences in age and ER status are not a result of access to care and are unexplained.
AB - Purpose We compared a cohort of Haitian immigrants with residents in Haiti with breast cancer (BC) to evaluate the effects of location on presentation, treatment, and outcomes. Patients and Methods Participants were Haitian women with BC living in Miami who presented to the University of Miami/Jackson Memorial Hospital and women with BC living in Haiti who presented to the Innovating Health International Women’s Cancer Center. The primary outcome was the relationship between location, cancer characteristics, and survival. The secondary objective was to compare our results with data extracted from the SEER database. Cox regression was used to compare survival. Results One hundred two patients from University of Miami/Jackson Memorial Hospital and 94 patients from Innovating Health International were included. The patients in Haiti, compared with the patients in Miami, were younger (mean age, 50.2 v 53.7 years, respectively; P = .042), presented after a longer duration of symptoms (median, 20 v 3 months, respectively; P < .001), had more advanced stage (44.7% v 25.5% with stage III and 27.6% v 18.6% with stage IV BC, respectively), and had more estrogen receptor (ER) –negative tumors (44.9% v 26.5%, respectively; P = .024). The percentage of women who died was 31.9% in Haiti died compared with 17.6% in Miami. Median survival time was 53.7 months for women in Haiti and was not reached in Miami. The risk of death was higher for women in Haiti versus women in Miami (adjusted hazard ratio, 3.09; P = .0024). Conclusion Women with BC in Haiti experience a significantly worse outcome than immigrants in Miami, which seems to be related to a more advanced stage and younger age at diagnosis, more ER-negative tumors, and lack of timely effective treatments. The differences in age and ER status are not a result of access to care and are unexplained.
UR - http://www.scopus.com/inward/record.url?scp=85053360981&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053360981&partnerID=8YFLogxK
U2 - 10.1200/JGO.2016.005975
DO - 10.1200/JGO.2016.005975
M3 - Article
AN - SCOPUS:85053360981
VL - 3
SP - 389
EP - 399
JO - Journal of global oncology
JF - Journal of global oncology
SN - 2378-9506
IS - 4
ER -