Disparities in minority patients with breast cancer under 40 years of age: A single center experience

e18553 Background: Current guidelines recommend screening for breast cancer (BC) starting at age 40. However, BC in women under 40 years is increasing in incidence. Pathogenic germline mutations are found to be the driving force in nearly 17% of those diagnosed under 45 years and 50% of those under 30 years. Limited data is available on the prevalence of pathogenic mutations in minority patients. We conducted a retrospective analysis of young breast cancer patients from low socioeconomic backgrounds between 2010-2022 at a single center in Central Texas. Methods: Patients were selected based on a diagnosis of BC under 40 years old and living at or below 200% of federal poverty level as noted through their insurance status of Medicaid and Medical Assistance Program of Travis County. Data regarding age of diagnosis, demographics, clinical presentation, staging, germline mutations and outcomes were extracted from the medical record. Descriptive statistics were used to analyze the dataset. Results: A total of 125 patients were identified for the study. Median age of the cohort was 35 years old (range: 19-39 years). Demographics included 61 Hispanic patients (48.8%), 40 White patients (32.0%), 16 Black patients (12.8%) and < 2% for each other group. Analysis of germline mutations was available for 86 patients. High risk mutations were identified in 28 patients, including 13 Caucasian women, 10 Hispanic women, and three Black women. BRCA mutations were the most common mutation (75%). Other mutations included CHEK2 (7.2%), MUTYH (7.2%), ATM (3.6%), PIK3CA (3.6%), PTEN (3.6%), RAD51C (3.6%) and RAD51D (3.6%). Variants of unknown significance were found in 18 patients, including 11 Hispanic women, four Black women and two White women. Forty patients had BC independent of mutations. Staging on initial diagnosis was available for 113 patients, 40.7% of which were locally advanced (28.3% in Stage III disease and 12.4% with metastatic disease). Advanced disease was higher in Hispanic patients (22/61) and Black patients (10/16) compared to White patients (10/40). Breast cancer subtypes included 22.8% with triple negative BC, 8.1% with HER2-enriched BC, 27.9% with hormone receptor (HR) positive and HER2 negative BC and 14.0% with both HR and HER2 positive BC. At the time of data review, only 30 patients were documented to have died, of which 22 died within five years of diagnosis. Five year death rate was 26.2% for Hispanic patients, 18.8% for Black patients and 7.5% for White patients in the study cohort. Conclusions: This study shows disparities among young Hispanic and Black patients with BC, particularly in the initial staging of BC and 5-year death rate. A large number of VUS were seen in minorities, suggesting little is known about the pathogenic nature of these mutations. Future prospective studies should consider investigating interplay between race and outcomes of those diagnosed with BC under 40 years old.