Breast carcinoma survival analysis for african american and white women in an equal-access health care system

108

BACKGROUNDAfrican‐American women have a significantly worse prognosis from breast carcinoma compared with white women, even when the stage at diagnosis is equivalent. The purpose of this study was to analyze racial differences in the treatment (use of breast‐conserving surgery and radiation therapy) of women with early‐stage breast carcinoma and the resulting effects on survival rates.METHODSSubjects included 10,073 African‐American and 123,127 white women diagnosed with Stage I, IIA, or IIB breast carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results program between 1988 and 1998. Comparisons were made by race with treatment, age, hormone receptor status, and stage at the time of diagnosis. Survival analyses were conducted to compare risk of death for African‐American and white women while controlling for age, stage, and hormone receptor status.RESULTSAmong women diagnosed with early‐stage breast carcinoma who receive breast‐conserving surgery, African‐American women were significantly less likely to receive follow‐up radiation therapy in every 10‐year age group except in the older than 85 age group. Whether treatment was equivalent or suboptimal, survival for African‐American women with early‐stage breast carcinoma was significantly worse. However, when treatment was equivalent, the effects of racial differences on survival were significantly less compared with survival associated with suboptimal treatment.CONCLUSIONSSignificant racial differences exist in the treatment of women with early‐stage breast carcinoma. Public health efforts to eliminate suboptimal treatment would reduce, but not eliminate, racial disparity in survival. Cancer 2002;95:1759–66. © 2002 American Cancer Society.DOI 10.1002/cncr.10827

Section: Discussionsupporting

confidence: 85%

Racial differences in treatment and survival from early‐stage breast carcinoma

Joslyn

2002

108

“…[2][3][4][5][6][7][8] Possible explanations advanced for this disparity in breast cancer mortality include lack of access to health insurance and medical care, 25 differences in treatment, 26,27 or socioeconomic factors. 7,28,29 Other investigations have shown that equal access to medical care does not eliminate completely the survival disadvantage for African American women, [30][31][32][33] and race alone has been suggested as an independent predictor for survival. [34][35][36] African American women were noted to have significantly earlier age at diagnosis, high grade tumors, and a higher proportion of ERnegative and PR-negative cancers, 3,6,[37][38][39][40][41][42] suggesting that breast cancer is biologically different in African American women.…”

Section: Discussionmentioning

confidence: 93%

Descriptive analysis of estrogen receptor (ER)‐negative, progesterone receptor (PR)‐negative, and HER2‐negative invasive breast cancer, the so‐called triple‐negative phenotype

Bauer

Brown

Cress

et al. 2007

1,812

105

1,442

BACKGROUND.Tumor markers are becoming increasingly important in breast cancer research because of their impact on prognosis, treatment, and survival, and because of their relation to breast cancer subtypes. The triple‐negative phenotype is important because of its relation to the basal‐like subtype of breast cancer.METHODS.Using the population‐based California Cancer Registry data, we identified women diagnosed with triple‐negative breast cancer between 1999 and 2003. We examined differences between triple‐negative breast cancers compared with other breast cancers in relation to age, race/ethnicity, socioeconomic status (SES), stage at diagnosis, tumor grade, and relative survival.RESULTS.A total of 6370 women were identified as having triple‐negative breast cancer and were compared with the 44,704 women with other breast cancers. Women with triple‐negative breast cancers were significantly more likely to be under age 40 (odds ratio [OR], 1.53), and non‐Hispanic black (OR, 1.77) or Hispanic (OR, 1.23). Regardless of stage at diagnosis, women with triple‐negative breast cancers had poorer survival than those with other breast cancers, and non‐Hispanic black women with late‐stage triple‐negative cancer had the poorest survival, with a 5‐year relative survival of only 14%.CONCLUSIONS.Triple‐negative breast cancers affect younger, non‐Hispanic black and Hispanic women in areas of low SES. The tumors were diagnosed at later stage and were more aggressive, and these women had poorer survival regardless of stage. In addition, non‐Hispanic black women with late‐stage triple‐negative breast cancer had the poorest survival of any comparable group. Cancer 2007. © 2007 American Cancer Society.

“…Wojcik et al 25 reported survival differences between African-American and Caucasian women who had equal and free access to healthcare services through the Department of Defense (DoD). Their findings suggested that for African-American women the risk of breast carcinoma mortality relative to the race-specific national average was reduced.…”

Section: Resultsmentioning

confidence: 99%

Race modifies the association between breast carcinoma pathologic prognostic indicators and the positive status for HER‐2/neu

Stark

Claud

Kapke

et al. 2005

BACKGROUNDInferences about the variations in the biology of breast carcinoma between African‐Americans and Caucasians have been reported. The difference in the prevalence of positive HER‐2/neu breast carcinoma was evaluated and the race‐specific risk was assessed for positive HER‐2/neu among a cohort of women diagnosed with their first primary breast carcinoma, given the accepted prognostic pathologic indicators for positive HER‐2/neu status.METHODSDemographic, clinical, and pathologic data were collected from existing databases. The status of HER‐2/neu was considered positive if the immunohistochemistry score was 3+ or if the fluorescent in situ hybridization indicated a ratio greater than 2. Multivariable logistic regression was used to determine the race‐specific risk for HER‐2/neu positive breast carcinoma.RESULTSThe difference in the prevalence of HER‐2/neu‐positive status between African‐American and Caucasian women was not statistically significant (P = 0.46). For Caucasian women the likelihood for positive HER‐2/neu was statistically significant and increased almost linearly within each stage with nuclear grade dedifferentiation relative to the reference group, women with Stage 1, Grade 1 carcinomas. For African‐American women, this risk was not significantly associated with stage, nuclear grade, their interaction term, or other pathologic prognostic indicators.CONCLUSIONSThe findings suggest that race modifies the association between the pathologic prognostic indicators of breast carcinoma and the likelihood of HER‐2/neu‐positive carcinoma. So far, clinical correlative studies of HER‐2/neu have not included race as an independent variable. Concerns about the limited generalizability and the need for validation of the findings across racial lines have been expressed previously. Cancer 2005. © 2005 American Cancer Society.