Abstract A069: A scoping review on racial and ethnic disparities in cardiovascular outcomes among U.S. Breast cancer survivors

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and non-cancer mortality among U.S. breast cancer survivors. Differences in risk factors and receipt of cardiotoxic cancer treatment may contribute to disproportionate cardiovascular outcomes by race and ethnicity. This scoping review comprehensively evaluated racial and ethnic disparities in CVD outcomes among U.S. breast cancer survivors. We searched SCOPUS, PubMed, and EMBASE for empirical studies evaluating CVD outcomes among breast cancer survivors by race and ethnicity published between 2005-2026, yielding 67 records. Inclusion criteria were journal articles that 1) peer-reviewed cohort studies, 2) included U.S. women aged ≥18 years with primary breast cancer 3) assessed CVD incidence or mortality, and 4) compared ≥ 2 racial and ethnic groups (White, Black, Asian American, Pacific Islander, American Indian/Alaska Native, Hispanic) and/or subgroups (e.g. Asian ethnicities). Fourteen cohort studies of U.S. female breast cancer survivors (12 retrospective; 2 prospective) met inclusion criteria. Eight studies examined incident CVD by race and ethnicity, with highest incident all-cause and cause-specific CVD (e.g. heart failure, myocardial infarction, stroke, etc.) reported for Black women. Compared to White survivors, studies reported similar incident CVD risk for Hispanic and American Indian/Alaska Native women and lower risks for aggregated Asian American and Pacific Islander women. When disaggregated, there was significant variation in risks, with the greatest CVD incidence for Pacific Islander, South Asian, Vietnamese, and Korean breast cancer survivors. Ten studies reported racial and ethnic disparities in CVD mortality, and the highest risks were reported for younger Black women. However, CVD mortality was lower among postmenopausal Black women and similar among those aged ≥70 years, compared to White women. Only one study examined Hispanic and American Indian/Alaska Native survivors, reporting similar mortality risk to White survivors. Aggregated Asian American and Pacific Islander breast cancer survivors had lower CVD mortality risk than White survivors. Four studies reported heterogenous CVD mortality when disaggregated: Pacific Islander survivors had similar or elevated risks compared to White women, whereas East Asian and Other Asian survivors had lower risks. Within Asian American and Pacific Islander women, Pacific Islander survivors had > 2 times higher CVD mortality risk than Asian survivors, and South and Southeast Asian survivors experienced higher risk than East Asian survivors. Racial and ethnic disparities in CVD incidence and mortality were observed among U.S. breast cancer survivors, especially for younger Black women, and heterogeneity was observed within Asian American breast cancer survivors. Future research should identify the clinical, treatment-related, and social factors contributing to these disparities to inform targeted prevention and survivorship care. Isha Patel, La-Urshalar Brock, Yuehan Wang, Michelle Sodipo, Katherine L. Ho, Angel Hokulani. Pajimola, Lene H.S. Veiga, Lauren E. McCullough, Nida Waheed, Jaimie Z. Shing, Gretchen L. Gierach, Jacqueline B. Vo. A scoping review on racial and ethnic disparities in cardiovascular outcomes among U.S. Breast cancer survivors [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A069.