Document Type
Article
Publication Date
12-26-2025
Abstract
PURPOSE: To understand how access to care influences metastatic breast cancer burden (MBC) while accounting for molecular tumor characteristics, and identify interventions to reduce metastatic disease burden.
METHODS: The Carolina Breast Cancer Study is a population-based cohort with invasive breast cancer (diagnosed 2008-2013). Both de novo metastasis (stage IV at diagnosis) and distant recurrence were evaluated (12 years of follow-up. Tumor data were from medical records, pathology reports, and RNA expression data. Social variables and access to care were from participant surveys. Generalized linear models were used to estimate associations of biological and access characteristics with MBC; Cox models were used to estimate recurrence hazards.
RESULTS: 464/2998 patients (15.5%) had MBC (n = 109 de novo; n = 355 recurrent). MBC was associated with grade 3 vs 1 (odds ratio (OR) = 4.15, 95% CI: 2.60, 6.99), LumB vs LumA (OR = 2.08, 95% CI: 1.48, 2.90), and high vs low PAM50 risk of recurrence score (OR = 4.45, 95% CI: 2.93, 6.99) vs. non-MBC. MBC was associated with Black race (Hazard ratio (HR) = 1.66, 95% CI: 1.32, 2.11), poverty (HR = 1.47; 95% CI: 1.09, 1.99), and low education (HR = 1.48, 95% CI: 1.03, 2.13). Controlling for healthcare access (screening, regular care, delayed treatment, and community healthcare) attenuated associations with metastasis for poverty and education, but had lesser effects on race associations.
CONCLUSIONS: Disparities in MBC burden persist after adjustment for individual- and community-level healthcare access. Reducing burden of MBC in Black women necessitates simultaneous targeting of biological and access to care factors.
Recommended Citation
Dunn, Matthew R.; Van Alsten, Sarah C.; Emerson, Marc A.; Reeder-Hayes, Katherine; Hyslop, Terry; and Troester, Melissa A., "Tumor Biology and Access to Care and Metastatic Breast Cancer Outcomes" (2025). Kimmel Cancer Center Faculty Papers. Paper 170.
https://jdc.jefferson.edu/kimmelccfp/170
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
41452486
Language
English
Comments
This article is the author's final published version in Breast Cancer Research and Treatment, Volume 215, Issue 2, January 2026, Article number 46.
The published version is available at https://doi.org/10.1007/s10549-025-07881-6. Copyright © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2025.