Breast Cancer Stage Among Ukrainian Refugees in Poland.

Importance: Millions of Ukrainians displaced by war have sought refuge in Poland, posing challenges for cancer care. Determining whether these refugees present with more-advanced breast cancer is crucial for guiding resource allocation. Objective: To evaluate the associations between Ukrainian refugee status and clinical presentation of breast cancer compared with Ukrainian permanent residents in Poland and the general Polish population. Design, Setting, and Participants: This retrospective cohort study was conducted between February 2021 and February 2024 at a single tertiary oncology center (Lower Silesian Oncology, Pulmonology, and Hematology Centre, Wrocław, Poland) and included adult women with a diagnosis of stage 0 to IV breast cancer, regardless of treatment intent. Participants were categorized as Ukrainian permanent residents (UPRs), Ukrainian war refugees (UWRs), or general Polish population (GPP). Exposures: War refugee status (UWR) vs permanent residence (UPR) vs general Polish population (GPP) and a diagnosis of breast cancer. Main Outcomes and Measures: Primary outcomes were clinical stage (0-IV) at diagnosis, tumor grade (G1-G3), and age at presentation. Stage distributions and odds ratios (ORs) were evaluated using weighted logistic regression, adjusting for age and time period (before the war, first war year, and second war year). Results: Of 3259 patients, 44 were in the UWR group (mean [SD] age, 52.9 [13.5] years), 72 were in the UPR group (mean [SD] age, 49.9 [11.4] years), and 3143 were in the GPP group (mean [SD] age, 59.5 [12.6] years). Stage III to IV disease occurred in 19 patients (43.2%) in the UWR group vs 849 patients (27.0%) in the GPP group. Adjusted analysis showed that refugees had a 2.00-fold increased odds (95% CI, 1.06-3.76; P = .03) of stage III to IV disease and 2.42-fold increased odds (95% CI, 1.29-4.55; P = .006) of grade 3 tumors. Conclusions and Relevance: In this retrospective cohort study, war refugee status was associated with a higher prevalence of aggressive tumor grades and more-advanced stage disease at diagnosis. Although aggressive breast cancer subtypes are more common in younger women, the disproportionate burden of advanced disease in this cohort highlights the impact of health care access barriers and delayed presentation. These findings underscore the need for tailored strategies, such as accessible screening and early diagnostic interventions, to improve outcomes among Ukrainian refugees in Poland.