Health-State Utility Impacts of Breast Cancer Diagnosed in U.S. Women Aged 15 to 44, by Race and Ethnicity

Background: Breast cancer negatively affects women’s health-related quality of life (HRQoL), but less is known about this effect among women aged 15 to 44 years or how it varies by race/ethnicity. The effect of breast cancer on HRQoL may be larger among younger women compared with older women due to chemotherapy-induced menopause, decreased sexual function, infertility, and other side effects. Due to more aggressive and less responsive tumors, breast cancer diagnosed at a younger age is also correlated with lower survival rates, higher recurrence rates, and negative prognostic variables. To our knowledge, no population-based national sample has been used to estimate the HRQoL decrement in terms of health-state utilities (HSUs) from breast cancer by age at diagnosis and race/ethnicity.

Purpose: This study measures preference-based HSU values for women with breast cancer by age at diagnosis (15 to 44 years, > 45 years) and race/ethnicity (white, African American, and Hispanic).

Methods: The analysis sample, drawn from the 2009 and 2010 Behavioral Risk Factor Surveillance System, included 1,407 women diagnosed with breast cancer between age 15 and 44 (1,133 white, 123 African American, 64 Hispanic, and 87 other) and 6,050 women diagnosed at age ≥45 (5,203 white, 375 African American, 217 Hispanic, and 255 other). We estimated HSU values using Healthy Days variables and a published algorithm. The Healthy Days measures provide valid descriptive information about HRQoL, but no “preference-based” valuation of Healthy Days exists to date. We used Jia and Lubetkin’s mapping from Healthy Days measures to the EQ-5D, for which preference weights for the U.S. population exist. Because women without cancer cannot be stratified by age at breast cancer diagnosis, we used five-to-one nearest neighbor propensity score matching to match women with breast cancer to statistically similar women without breast cancer, separately by age at diagnosis and race/ethnicity.

Results: The breast cancer HSU decrement 0 to 1 year after diagnosis is larger for women diagnosed at age 15 to 44 than for women diagnosed at age >45 (−0.131 vs. −0.068; p < 0.05). Among the younger age-at-diagnosis group, Hispanic women had the largest HSU decrement 2 to 4 years after diagnosis (−0.330; p < 0.05), followed by non-Hispanic white women 0 to 1 year after diagnosis (−0.150; p < 0.05) and African American women 0 to 1 year after diagnosis (−0.140; p < 0.1).

Conclusions: The effect of breast cancer on HSU varies by age at diagnosis, time since diagnosis, and race/ethnicity. Separate quality-of-life adjustments for women by age at diagnosis and race/ethnicity are important for cost-effectiveness analysis of breast cancer prevention, detection, and treatment.