Disparities in Breast Cancer Treatment and Reconstruction Among Native Hawaiian and Pacific Islander Women: Systematic Review and Meta-Analysis

Abstract

Background: Native Hawaiian and Pacific Islander (NHPI) women experience significant disparities in breast cancer treatment and outcomes, including lower rates of postmastectomy reconstruction, higher refusal rates of radiation therapy, and delays in surgical care. These disparities contribute to poorer survival and increased complications compared to other racial/ethnic groups. This systematic review and meta-analysis aim to quantify these disparities and assess their impact on breast cancer outcomes in NHPI women.

Methods: A comprehensive search of PubMed, Scopus, and Embase databases was conducted to identify studies reporting on breast cancer surgery, reconstruction, radiation therapy refusal, and surgical delays for NHPI women. Thirteen studies, encompassing a total of 5 546 918 patients, were included, and meta-analyses were performed to pool odds ratios (OR) and hazard ratios (HR) for key outcomes using random-effects models. Heterogeneity was assessed using I² statistics. Thematic analysis was also conducted to explore cultural and structural factors influencing treatment disparities.

Results: NHPI women had significantly lower odds of receiving postmastectomy reconstruction compared to non-Hispanic White women (pooled OR = 2.02, 95% confidence interval [CI]: 1.96-2.08, I² = 99%). Delays in surgical care were more frequent, with NHPI women being 4.51 times more likely to experience delays (OR = 4.51, 95% CI: 3.82-5.32, I² = 99%). Radiation therapy refusal was notably higher, with a pooled hazard ratio of 3.28 (95% CI: 2.99-3.58, I² = 77%) indicating that NHPI women who refused radiation therapy had more than three times the risk of mortality compared to those who accepted it. Thematic analysis revealed that geographic isolation, limited access to specialized care, and cultural perceptions surrounding cancer treatments, including fear of radiation due to historical trauma, contributed significantly to treatment disparities.

Conclusions: Native Hawaiian and Pacific Islander women face considerable barriers to receiving equitable breast cancer treatment and reconstruction, resulting in worse outcomes compared to other racial/ethnic groups. Efforts to address these disparities must focus on improving access to care, reducing treatment delays, and implementing culturally sensitive interventions. Targeted policies and healthcare system improvements, especially in geographically isolated areas, are critical to improving survival and treatment outcomes for NHPI women.