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Mego 1 Authors place of work: Klin Onkol ; 30 1: Roma Gypsies constitute one of the largest ethnic minorities in Slovakia. Some reports have supported a higher prevalence of communicable diseases in Roma but data on cancer prevalence in Roma is absent.

The aim of this study was to compare differences in the incidence and pathological characteristics of breast cancer between Roma and non-Roma in Slovakia. The database from the last Census of Slovakia in was matched by gender, date of birth, and residency with the HER2 Registry from to Based on the match, Roma and non-Roma breast cancer patients were identified.

Psnik and 5, women with breast cancer were identified as Roma and non-Roma, resp. The age-standardized breast cancer incidence rate was psnikz. Roma patients were younger than non-Roma patients median 49 vs. Roma patients had more hormone receptor negative For the first time, this study has revealed that the incidence and biological characteristics of breast cancer are different between Roma and non-Roma. Our data suggests that Roma patients are younger at diagnosis, have a lower age-standardized breast cancer incidence rate, and have more aggressive tumors than non-Roma.

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They originally came from Northern India and nowadays about 12 million Roma psnnika live worldwide [1]. Roma people have been the subject of stigmatisation and isolation from the majority population throughout history [1]. It is estimated that more thanRoma live in Slovakia [2]. However, in the last official Slovak Census in only 2. Roma people have poorer education and poor education is closely associat-ed with many social and health problems [4].

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It is believed that the health of Roma people is poorer than the health of the majority of the population, however these inequalities have not been sufficiently studied. One of the problems in executing a study in the Roma population is that data could be misused and the Roma could be stigmatised.

Thus, Roma ethnicity has not been generally recorded and studied in the clinical trials [1]. Evidence also exists about poor communication between Roma and healthcare workers pznika low realisation of preventive care, including vaccination and screening programmes in Roma [1]. Most studies published on Roma health are on communicable diseases, however they are mostly community studies with limited sample size [1,5,6].

The available evidence suggests a higher predisposition of Roma to outbreaks of infectious diseases, especially those that are associated with unsanitary conditions and low rate of vaccination, as well as possibly a higher risk of contracting human immunodeficiency virus [1,5—16]. Data suggest higher rates of non-communicable and chronic diseases in Roma when compared with the majority population. However, the generalisability of most studies is limited due to the large non-response rate, small sample sizes and no adjustment for confounders [6].

Higher rates of diabetes mellitus and obesity, high blood pressure, end-stage renal disease and metabolic syndrome have been reported in Roma when compared to non-Roma [17—22]. Risky health behaviour was observed in Roma with a diet high in animal fat, low in fruits and vegetables, a high prevalence of smoking history and low physical activity [23]. There have been disparities reported in treatment outcomes and biology of oncology diseases in different racial and ethnic groups.

For example, African American women have a lower lifetime incidence of breast cancer BC than white women, however the risk of BC mortality and incidence in ages less than 45 years is higher [24,25]. African American women are also more likely diagnosed with BC at an advanced stage and tumors are more likely to be poorly differentiated and triple negative TN when compared with tumors in white women.


These biological features were also more commonly observed among women from western, sub-Saharan Africa who share common ancestry with African American women [26]. Finally, it was also reported that African Americans with BC were less likely to receive optimal care compared with Caucasian Americans and this might contribute to poorer outcomes.

Oncology diseases have been prac-tically unstudied in the Roma population and only one study from the Czech Republic reported on the incidence of cervical cancer, which was It is therefore the aim of this study to compare incidence and pathological characteristics between Roma and non-Roma BC patients in Slovakia.

All BC patients registered in the HER2 Registry from through with complete information about histology, date of birth, gender and address were included. All people who identified themselves as having Roma nationality or speaking the Roma language were selected from the last Slovak Census in SC and identified as Roma people. The Roma female patients for our study were identified based on matching, gender, date of birth and address, of all patients registered in the HER2 Registry from through with Roma people identified in the SC Non-Roma patients were identified as all patients except Roma patients.

Age at diagnosis, age-standardised incidence ASIhistological and biological characteristics of Roma patients were then compared with non-Roma patients.

HER2 Registry collects data from the files in information systems of all pathology departments and laboratories in Slovakia examining either core-cut or resec-tion biopsies of patients with BC verified by biopsy. This centralised Registry was founded in January Data integrity is based on the Formulary of the Registry requiring entry of identical algorithmically standardised data for every patient. Patient characteristics were tabulated.

Normality of distribution was tested by the Kolmogorov-Smirnoff test. Logistic regression model was used in multivariate analysis. The age-standardised incidence rate ASIR is defined as a summary measure of the rate that a given population would have if it had a standard age structure. Psniak ASIR is a weighted pnsika of the age-specific rates; the weights are given by population distribution of a standard population.

Slovak Population in was used as a standard population. The age-standardised incidence rate is expressed perpeople. Based on data from the SC,of 5, Slovak people identified themselves as having Roma nationality or as speaking the Roma language.

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There have been 10, records entered in the HER2 Registry from through By using gender, date of birth and address, we matched the HER2 Registry database with the Census database and we identified 33 Roma and 6, non-Roma female patients with BC. Further, we excluded those patients who did not have a complete pathology report and, finally, 32 Roma and 5, non-Roma women with BC were identified and used for the comparison psnija age at diagnosis, ASI age-standardised incidenceand histology and biological characteristics.

Age distributions of study populations are presented in Tab. Age distribution of the analyzed populations. The BC incidence rate was 17 and 36 peru for Roma and non-Roma women, resp. Non-Roma BC women had 2. The comparison of histology and biological characteristics between Roma and non-Roma BC patients is presented in Tab.

Roma had statistically sig-nificantly more hormone receptor negative HR— Roma women had 2. Biological characteristics of the analyzed populations.

Multivariate analysis of variables associated with hormone receptor negativity. Roma people are one of the largest ethnic minorities living in Slovakia, but their health needs have been poorly studied.

The factors that might explain ethnic health disparities were categorised into racial-genetic, health-behaviour, socio-economic, psychoso-cial stress and structural-constructivist models [27]. Studies searching for possible differences in cancer incidence, prevalence and mortality, and treatment outcomes in different ethnic groups have already been published [24—26,28—37].

There was, however, only few reports published on cancer in Roma [1,38]. The aim of our study was to compare the age at diagnosis, ASI age-stan-dardised incidenceand histological and biological characteristics between Roma and non-Roma BC women.


The HER2 Registry collects pathology reports from the patients with breast tumors, and n and gastro-oesophageal cancer in Slovakia. There were 10, records entered in the HER2 Registry from through In 1, patients, more than one re-cord was merged into one single record and psnjka 9, patients were identified.

More than one record in one patient was caused by more than one examination of the histological sample e. Further, we excluded the patients with other than BC or unavailable histology, and male patients, and we identified 7, female BC patients.

In the last report from the Slovak National Oncology Registry NORwhere all new oncology psnioa in Slovakia are registered, there were 2, new females with BC registered in [39]. The absolute number of cases as well as ASI gradually increases each year. The absolute number of cases and ASI was 2, and Based on data from NOR, we might expect approximately 9, new cases of BC in women in a 3-year period of time from through We were able to identify 7, women with BC, which is The SC identified 5, people living in Slovakia and it is estimated that There werepeople who were recorded to have Roma nationality or to use the Roma language, and these people 2.

Based on information from the Atlas of Roma Communities in Slovakia, the estimated number of Roma living in Slovakia is about7. Matching of the HER2 Registry database with the database from SC was based on use of gender, date of birth and address information and thus we had to exclude 1, patients with unknown addresses and dates of birth.

We were able to identify 33 Roma and 6, non-Roma women with BC. Because the purpose of our study was to compare age at diagnosis, ASI, histological and biological characteristics pwnika Roma and non-Roma women with BC, we further excluded 1 Roma and non-Roma as their records were not complete. Finally, 32 Roma and 5, non-Roma women with BC were identified for our analysis.

The median age of Roma women with BC was statistically significantly lower when compared to non-Roma. According to the psnikka data from SC, the mean age of Slovak men and women in was The mean age of Roma people registered in SC was It is also estimated that the life expectancy of Roma psnjka is more than 10 years lower than for non-Roma people [1,3,40].

There could be several explanations for the younger age of Roma women at diagnosis of BC.

This discrepancy could lead to unbalanced comparisons with statistical error caused by the relatively small sample number of Roma patients. The percentage of Roma patients was only 0. Secondly, the median age when BC is diagnosed in the general population is after 60 years of age.

Therefore, we could expect that we will pznika less likely to diagnose older Roma women with BC, as Roma women tend to die younger. Fourthly, there might be underdiagnosis of BC in older Roma women because of cultural, psychosocial or socio-economic reasons in comparison with younger Roma and thus we could not identify these Roma BC patients. Psniika, there is also a possibility that older Roma women are less likely to admit their Roma nationality and so we could not identify older Roma women in SC and thus in the HER2 Registry.

The age-standard-ized incidence was 36 and 17 pernon-Roma and Roma, resp. Expected ASI is thus comparable to our observation 36 women perpeople. It is probable that Roma women participate less than non-Roma in the screening programs and that lower participation could lead to a lower incidence rate of BC in Roma.