PPS34. Neighborhood disadvantage and pathologic complete response to neoadjuvant chemotherapy in breast cancer patients

Friday, March 6, 2026

3:40 PM - 4:10 PM MST

Location: HUB Poster Park - West Hall 1-3

Poster Presenter(s)

Taylor Maramara, MD (she/her/hers)

Breast Surgical Oncology Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Co-Author(s)

Yashasvini Sampathkumar, MD (she/her/hers)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
Montclair, New Jersey, United States
RJ

Robert James, MD

Breast Service, Department of Surgery
Memorial Sloan-Kettering Cancer Center
NY, New York, United States
Jacquelyn Dillon, MD (she/her/hers)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
NY, New York, United States
RK

Risa Kiernan, DO

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
YZ

Y. Helen Zhang, MD

Memorial Sloan-Kettering Cancer Center
New York, New York, United States
Brenden Bready, MS, BS (he/him/his)

Assistant Research Biostatistician
Memorial Sloan-Kettering Cancer Center
New York, New York, United States
VS

Venkatraman Seshan, PhD

Memorial Sloan-Kettering Cancer Center
New York, New York, United States
GP

George Plitas, MD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Monica Morrow, MD (she/her/hers)

Chief, Breast Service, Department of Surgery; Anne Burnett Windfohr Chair of Clinical Oncology; Vice President, Women in Science and Medicine, MSKCC; Professor of Surgery, Weill Cornell Medical College of Cornell University
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Primary Author(s)

NG

Neha Goel, MD, MPH

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Introduction: Breast cancer specific survival (BCSS) is decreased for women living in disadvantaged neighborhoods. Barriers to completing guideline-concordant therapy are a major contributing factor. Recent studies have shown that ADI is associated with more aggressive tumor biology (e.g., high grade, triple negative breast cancer). Although these tumor characteristics have been associated with higher pathologic complete response (pCR) rates, the shorter BCSS seen with highly disadvantaged neighborhoods, led us to hypothesize that pCR is less frequent among women living in disadvantaged compared to advantaged neighborhoods after completing guideline-concordant neoadjuvant chemotherapy (NAC).

Methods: Women with stage I–III BCa undergoing neoadjuvant chemotherapy between 2014-2023 were identified from Memorial Sloan Kettering Cancer Center’s prospectively maintained breast database. Patient demographics, tumor characteristics, treatment details, and final pathology were abstracted from the medical record and institutional cancer registry. Residential addresses were geocoded to census block groups and linked to the national ADI, categorized as low/medium (ADI 1-6) vs. high disadvantage (ADI 7-10). The primary outcome was pCR (ypT0/Tis ypN0). Associations between ADI and pCR were evaluated using multivariable regression models adjusting for age, race, insurance, subtype, clinical stage, and at least 80% NAC completion.

Results: Among 2,537 women with complete data, 36% achieved a pCR. The median age was 51 years. The cohort was comprised of 67% White, 18% Black, and 15% Asian patients; 60% had high-grade tumors, 69% had stage II disease, and 29% had TNBC. On multivariable analysis including completion of ≥80% of planned NAC, patients from highly disadvantaged neighborhoods had lower odds of pCR compared with those from low/intermediate-disadvantaged areas (OR 0.74, 95% CI 0.54–0.99, p = 0.045). Completing ≥80% of NAC was independently associated with higher odds of pCR (OR 1.66, 95% CI 1.26–2.21, p < 0.001). Higher grade (OR 6.22, 95% CI 4.97–7.84, p < 0.001), biologically aggressive subtypes [(HER2+: OR 6.15, 95% CI 4.79–7.93; TNBC: OR 2.38, 95% CI 1.83–3.11; p < 0.001)], and lower stage (Stage III vs II: OR 0.69, 95% CI 0.54–0.88, p < 0.001) were also significant predictors of pCR.

Conclusions: In addition to receptor status, grade, and lack of treatment completion, ADI was also an independent predictor of lower odds of a pCR after NAC. These findings merit further inquiry into potential mechanisms of treatment resistance among those living in disadvantaged areas.

Learning Objectives:

Explain the relationship between neighborhood disadvantage (ADI) and pathologic complete response (pCR) to neoadjuvant chemotherapy in breast cancer.
Identify how treatment completion contributes to differences in pCR rates across socioeconomic groups.
Identify how tumor biology contributes to differences in pCR rates across socioeconomic groups.