Social determinants of health and use of neoadjuvant chemotherapy and germline genetic testing in patients with early stage triple negative breast cancer (TNBC) in the community oncology setting

Abstract Purpose Triple negative breast cancer is a biologically aggressive cancer with limited treatment options. The disease behaves more aggressively in Black women, producing higher mortality rates. Methods With the aim of understanding reasons for this difference in outcomes, a retrospective, observational cohort study was conducted. We sought to correlate social determinants of health with use of germline genetic testing and administration of neoadjuvant chemotherapy. Results We observed lower use of germline genetic testing among patients who were Black (OR = 0.43, p = 0.007 vs. White) or from lower socioeconomic status neighborhoods (OR = 0.98, p = 0.001). Nonetheless, lower administration of neoadjuvant chemotherapy was seen in those of older age (OR = 0.95, p < 0.001) or on Medicaid insurance (OR = 0.54, p = 0.020 vs. commercial insurance), while higher administration was seen among patients that were Black (OR = 1.57, p = 0.044 vs. White), obese (OR = 1.46, p = 0.048 vs. normal BMI), or stages over IIA (all stages above IIA p < 0.001 vs. IIA). Conclusion Findings suggest that differences in outcomes seen in Black patients may be due to reduced use of germline genetic testing, but not reduced administration of neoadjuvant chemotherapy.