Influence of Ethnicity & Birthplace on Breast Cancer Clinical Features, Treatment, and Survival among Texas Women: Breast Cancer by Birthplace

Background: The influence of nativity on cancer outcomes has been described across several malignancies, but its role in breast cancer remains unclear. We examined whether birthplace is associated with differences in presentation, treatment, and mortality among women diagnosed with invasive breast cancer in Texas.Methods: We performed a retrospective cohort study using the Texas Cancer Registry, including 290 656 women diagnosed with primary invasive breast cancer between 1995 and 2018. Demographic, clinical, treatment, and mortality data were analyzed. Missing birthplace data were addressed using multiple imputation. Associations were evaluated using χ² or Fisher exact tests, and multivariable logistic regression was used to identify factors associated with all-cause mortality.Results: Foreign-born Hispanic and Asian women were more likely to present with metastatic disease at diagnosis compared to their US-born counterparts (Hispanic: 4.7% vs 2.7%; Asian: 3.3% vs 2.1%). Asian women demonstrated higher rates of radiation therapy use regardless of nativity. In multivariable analyses, foreign-born Hispanic (OR, 1.482; 95% CI, 1.419-1.548; P < .001) and foreign-born Asian women (OR, 1.172; 95% CI, 1.058-1.299; P = .002) had significantly higher odds of all-cause mortality compared to US-born non-Hispanic white women.Conclusion: Birthplace was associated with differences in breast cancer presentation, treatment patterns, and mortality outcomes.