Area Deprivation Index in patients with invasive lobular carcinoma of the breast: associations with tumor characteristics and outcomes

Abstract

Background: While investigators have shown associations between socioeconomic status (SES) and outcomes in breast cancer, there is a paucity of such data for invasive lobular carcinoma (ILC), the second most common type of breast cancer. Herein we evaluated the relationship between SES with tumor features and outcomes in stage I-III patients with ILC. Methods: We analyzed a prospectively maintained institutional ILC database and utilized the Area Deprivation Index (ADI) to determine neighborhood adversity, an indicator of SES. We used Cox proportional hazards models in Stata 17.0 to evaluate relationships between ADI quintile (Q), race, body mass index (BMI), clinicopathologic features, treatment type, and event-free survival (EFS). Results: Of 804 patients with ILC, 21.4% lived in neighborhoods classified as ADI Q1 (least resource-deprived) and 19.7% in Q5 (most resource-deprived). Higher deprivation was significantly associated with larger tumor size (3.6 cm in Q5 versus 3.1 cm in Q1), increased presence of lymphovascular invasion (8.9% in Q5 versus 6.7% in Q1), and decreased use of adjuvant endocrine therapy (67.1% in Q5 versus 73.6% in Q1). On multivariable analysis, tumor size, receptor subtypes, and omission of adjuvant endocrine therapy were associated with reduced EFS. Conclusions: These data show that patients with ILC and higher ADI experience more aggressive tumors and differences in treatment. More data evaluating the complex relationships between these factors is needed to optimize outcomes for patients with ILC, regardless of SES.