Ethno-religious inequities in clinical presentation and survivorship outcomes in breast cancer: A prospective cohort study.

Abstract

e13633 Background: Breast cancer disparities related to ethnicity and religion are well described in U.S.-based populations, but prospective data from other healthcare systems are scarce. No national studies have previously examined ethno-religious inequities in breast cancer presentation and survivorship in Israel. By providing the first prospective national data outside the U.S. context, this study addresses a critical gap in understanding how social and cultural determinants shape both stage at diagnosis and early survivorship outcomes. Methods: This ethics board–approved prospective cohort enrolled 219 consecutively diagnosed breast cancer patients during the 2025 calendar year. Participants included Arab Muslim women (N = 38), Jewish ultra-orthodox women (N = 51), and other Jewish women (N = 128). Clinical variables included age, menopausal status, mode of diagnosis, stage, tumor size, biologic subtype, and treatment patterns. Survivorship outcomes were assessed using validated instruments evaluating quality of life (FACT-G, FACT-BC), endocrine symptoms (FACT-ES), anxiety and depression (PROMIS), and spirituality (FACIT-Sp, Systems of Belief Inventory). Between-group comparisons were performed. By the time of presentation, correlative analyses between clinical characteristics and patient-reported outcomes will be completed. Results: Significant ethno-religious inequities were observed at diagnosis. Arab Muslim and ultra-orthodox Jewish women were younger and more often pre-menopausal (p = 0.016). Screening detection was less frequent among Arab Muslim women, who more commonly presented via self-palpation. Stage at diagnosis differed significantly by group (p = 0.011), with higher rates of metastatic disease among Arab Muslim (15.8%) and ultra-orthodox Jewish women (12.5%) compared with other Jewish women (2.4%; p = 0.012). Larger tumors (T3–4) were also more prevalent among minority groups (p = 0.015). Time from diagnosis to first treatment did not differ. Arab Muslim women reported significantly lower overall, physical, emotional, and functional quality of life and higher anxiety (all p < 0.05), despite significantly stronger spiritual wellbeing (p≤0.002). Ultra-orthodox Jewish women demonstrated higher overall and social quality of life and lower depression compared with other Jewish women (p≤0.034). Conclusions: Ethno-religious inequities in breast cancer are driven primarily by differences in early detection and stage at diagnosis, with distinct survivorship trajectories shaped by cultural and spiritual contexts. Equity-focused strategies should integrate early detection with culturally adapted survivorship care.