Ethnic differences in nonalcoholic fatty liver disease (NAFLD) among women with early-stage breast cancer receiving endocrine therapy.

Abstract

e12524 Background: NAFLD is a metabolic comorbidity increasingly recognized in oncology populations.Hormone receptor-positive (HR+) breast cancer (BC) is typically treated with endocrine therapy (ET). Both aromatase inhibitors (AIs) and tamoxifen are linked to metabolic side effects, including NAFLD, which complicate treatment outcomes and impact long-term health. Ethnic differences in the prevalence of NAFLD among women receiving ET for BC remain underexplored. Methods: We conducted a retrospective single-center analysis of adult female patients with HR+ early-stage BC (carcinoma in situ to stage III) between January 2012 and December 2022. Baseline demographic and clinicopathologic characteristics were collected. All patients received adjuvant ET for at least 6 months. Patients with baseline NAFLD, viral/autoimmune/alcoholic hepatitis, heavy alcohol use, or concurrent malignancies were excluded. Incidence and time to onset of NAFLD by imaging was measured. Primary analysis was restricted to patients who self-identified as Hispanic (H) or Non-Hispanic (NH). Chi-square or Fisher’s exact tests were used for categorical variables, and Mann-Whitney U tests for continuous variables. Multivariate Cox regression models were used to identify risk factors for NAFLD and analyze its impact on patient outcomes. Results: A total of 246 patients were analyzed, comprising 54 (22%) H and 192 (78%) NH. H patients were younger (median age 51.5 vs. 61 years, p < 0.0001), more frequently pre-menopausal (42.6% vs. 20.8%, p = 0.001) with lower prevalence of hypertension (27.8% vs. 44.8%, p = 0.025). No differences were noted between the two groups in BMI (median 29.1 vs. 27.4, p = 0.52), diabetes (14.8% vs. 12.5%, p = 0.66), or hyperlipidemia (31.5% vs. 36.4%, p = 0.5).Cancer stage at diagnosis and pathologic tumor characteristics did not significantly differ between the two groups.Treatment patterns showed more ovarian suppression (27.8% vs. 8.9%, p = 0.0003) and less chemotherapy use (14.8% vs. 33.3%, p = 0.008) in H vs. NH. No significant differences in recurrence-free survival ( p = 0.28) or overall survival ( p = 0.41) were noted. NAFLD incidence post-ET was significantly higher in H (22.2% vs. 11.5%, p = 0.043). Time to onset of NAFLD was also shorter in H compared to NH patients (HR 2.46, 95% CI 1.21–5.00, p = 0.01), with median durations not reached in either group. Multivariate analysis identified Hispanic ethnicity (HR 2.34, 95% CI 1.06–5.19; p = 0.036) and BMI (HR 1.10, 95% CI 1.04–1.17; p = 0.0015) as independent NAFLD risk factors. Conclusions: This study highlights the higher incidence and early onset of NAFLD in Hispanic women with early-stage breast cancer receiving ET, underscoring the unmet need for targeted screening, hepatic monitoring, and early lifestyle interventions for this high-risk population.