Association of socioeconomic status with the clinical management and outcomes in young patients (≤35 years) diagnosed with breast cancer: A retrospective analysis

BACKGROUND: Very young breast cancer at 35 years or younger is rare and tends to be aggressive. The management of very young breast cancer should be equally aggressive, and early diagnosis is critical. We hypothesized that socioeconomic status (SES) is associated with how very young breast cancer (VYBC) patients are diagnosed and treated in our community. METHODS: We retrospectively analyzed a database for invasive breast cancer or ductal carcinoma in-situ (DCIS) diagnosed ≤35 years old (VYBC) from both a government-run county hospital (CH) and a neighboring private hospital (PH) for 82 months. Inclusion criteria composed of female patients diagnosed with invasive breast cancer and DCIS at ≤35 years of age at diagnosis were examined in our analysis. Patient diagnoses and severity, treatment, and outcomes were compared between the two facilities. The methods are consistent with the STROCSS guidelines. RESULTS: The incidence of VYBC was a significantly higher percentage of new breast cancers diagnosed in the CH at 5.4% as compared to the PH at 1.9% (OR: 2.94; p < 0.001). CH had a significantly higher proportion of Medicaid payers (73% CH vs. 21% PH, p < 0.001). Mean time from patient's initial symptoms until a tissue diagnosis was significantly longer at the county hospital at 9.6 months vs 2.1 months at the private hospital (p < 0.01). Stage I tumors were only found in 13% of county hospital patients versus 67% at the private hospital (p < 0.001). Approximately 63% of the patients at the government-run county facility had a relative delay in diagnosis, contributing to higher stage at presentation. The rate of mastectomy surgery was high at both institutions: CH 83% vs. PH 76% (p = NS). DISCUSSION: The results of our study suggest a significant healthcare difference between county and private hospital systems among very young breast cancer patients. Patients at the county hospital system had a longer delay to diagnosis leading to worse outcomes. This difference may be a reflection of barriers in health literacy or access to medical care.