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Socioeconomic disparities in long-term heart failure risk of trastuzumab with or without anthracyclines in early-stage breast cancer: a SEER-Medicare database analysis
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  • Published: 25 February 2026

Socioeconomic disparities in long-term heart failure risk of trastuzumab with or without anthracyclines in early-stage breast cancer: a SEER-Medicare database analysis

  • Karissa Britten1,2,
  • Marla Lipsyc-Sharf1,
  • Eric H. Yang3,
  • Susan McCloskey4,
  • Mina S. Sedrak1,
  • Mediget Teshome5,
  • Julia LaBarbera1,
  • Aditya Bardia1 &
  • …
  • Nicholas McAndrew1 

npj Breast Cancer , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Breast cancer
  • Chemotherapy
  • Outcomes research
  • Targeted therapies

Abstract

While it is well-established that cardiovascular disease and congestive heart failure (CHF) are increased among breast cancer survivors, little is known about how systemic therapy use, medical comorbidities, and socioeconomic factors interact to influence long-term cardiac outcomes. In this study, we performed an analysis of the SEER-Medicare database, including more than 200,000 patients with early-stage breast cancer. Using available zip code and census data, patient disease characteristics and cardiac outcomes were stratified by socioeconomic variables. Overall, patients of Black, Hispanic, and American Indian/Alaskan Native race/ethnicity had an increased incidence of large, high-grade tumors and nodal involvement as compared to White and Asian American/Pacific Islander (AAPI) patients. Lower per capita income (PCI), higher percentage of population living in poverty, lower level of education, and not speaking English at home were also associated with increased tumor size, grade, and nodal stage. Adjusting for cardiac covariates and cancer therapy type, a multivariate socioeconomic model revealed that Black patients had a higher risk of CHF and AAPI patients had a lower risk compared to White patients. Further adjusting for race/ethnicity, patients living in a zip code in the lowest quartile of PCI also had a higher risk of CHF compared to those in the highest quartile.

Data availability

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

Code availability

Not applicable.

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Acknowledgements

The authors acknowledge the efforts of the National Cancer Institute; Information Management Services, Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.

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Authors and Affiliations

  1. Division of Hematology/Oncology, UCLA, Los Angeles, CA, USA

    Karissa Britten, Marla Lipsyc-Sharf, Mina S. Sedrak, Julia LaBarbera, Aditya Bardia & Nicholas McAndrew

  2. Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Karissa Britten

  3. UCLA Cardio-Oncology Program, Division of Cardiology, UCLA, Los Angeles, CA, USA

    Eric H. Yang

  4. Department of Radiation Oncology, UCLA, Los Angeles, CA, USA

    Susan McCloskey

  5. Division of Breast Surgical Oncology, UCLA, Los Angeles, CA, USA

    Mediget Teshome

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  1. Karissa Britten
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Contributions

K.B. and N.M. wrote the main manuscript text and prepared all tables/figures. K.B., M.L.S., E.H.Y., S.M., M.S.S., M.T., J.L., A.B., and N.M. reviewed and approved the manuscript.

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Correspondence to Karissa Britten.

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Britten, K., Lipsyc-Sharf, M., Yang, E.H. et al. Socioeconomic disparities in long-term heart failure risk of trastuzumab with or without anthracyclines in early-stage breast cancer: a SEER-Medicare database analysis. npj Breast Cancer (2026). https://doi.org/10.1038/s41523-025-00883-z

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  • Received: 21 April 2025

  • Accepted: 09 December 2025

  • Published: 25 February 2026

  • DOI: https://doi.org/10.1038/s41523-025-00883-z

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Racial and ethnic disparities in breast cancer

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