Date of Conferral

2021

Degree

Ph.D.

School

Public Health

Advisor

Richard Palmer

Abstract

Despite improved overall survival among breast cancer patients, race and biological subtype-specific disparities persist. Subsequently, this retrospective longitudinal study, guided by ecosocial theory, examined associations between biological subtypes of breast cancer and patient-level sociodemographic factors on survival outcomes in women 25 to 44 years of age. Using Surveillance, Epidemiology, and End Results (SEER) database, 34,007 breast cancer cases between 2013 and 2018 were extracted. Kaplan Meier method and Cox proportional hazards model were used to examine time to event and the adjusted mortality risk by race and breast cancer subtype. There was a statistically significant difference in survival among young Black women by biological subtype (χ2 (1) = 13.031, p < .05. Young black women with triple-negative breast cancer (TNBC) had a significantly increased risk of breast cancer death than young Black women with non-TNBC (hazard ratio [HR] = 2.220, 95% CI [1.373, 3.589]). Additionally, young Black women with TNBC experienced worse survival outcomes than young White women with TNBC (adjusted HR = 3.613, p = .001). Statistically significant interactions between geographic location (GL), median household income (MHI), and tumor subtype were observed. Interactions between GL, MHI, and biological subtype are potential drivers of unequal survival outcome between Black and White women. Social change implications include increased knowledge of the breast cancer mortality disparity. Understanding the causes of poor survival outcomes will help develop evidence-based interventions and policies to address the socioeconomic and physical environment disadvantages affecting young Black women with breast cancer.

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