Meta-Analysis of Survival in African American and White American Patients With Breast Cancer: Ethnicity Compared With Socioeconomic Status

BACKGROUND: Incidence and mortality of breast cancer vary according to demographic factors such as age, race/ ethnicity, socioeconomic status (SES), and geographic region. This study assesses the variation of these factors in the use of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) among 8 regions of California. METHODS: The authors identified 85,574 cases of first primary female invasive breast cancer with complete data diagnosed between January 1, 2000 and December 31, 2007. Logistic regression was used to determine the association between race/ethnicity, age, SES, and receipt of RT after BCS within each of the regions of California. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. RESULTS: Age was a significant predictor of receipt of RT after BCS in all regions. In Los Angeles (LA), lower SES was associated with decreasing odds of RT. Racial disparities were evident only in LA, where black (OR, 0.85; 95% CI, 0.74-0.97) and Hispanic (OR, 0.86; 95% CI, 0.78-0.96) women were about 15% less likely to receive RT than white women. CONCLUSIONS: Racial disparities in the receipt of RT after BCS exist only in LA, where African American and Hispanic women are less likely to receive this form of adjuvant treatment. Lower SES was also associated with a reduced likelihood of receipt of RT in LA. Women age 70 years and older are less likely to receive RT after BCS in all regions of California.

Section: Discussionmentioning

confidence: 99%

Disparities in receipt of adjuvant radiation therapy after breast‐conserving surgery among the cancer‐reporting regions of California

Parise

Bauer

Caggiano

2011

“…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: 99%

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

1,816

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.

“…21,49,50 Therefore, the current study responds to calls in the literature for analyses that include these variables. 7,9,10,37,51 …”

Section: Strengths/limitationsmentioning

confidence: 99%

“…Possible explanations include differences in screening mammography leading to differences in the stage and size of tumors at diagnosis, 5,6 tumor biology, inadequate receipt of appropriate breast cancer treatment, 5 and underlying patient comorbidities and socioeconomic factors. [7][8][9][10][11] Several studies have used Surveillance, Epidemiology, and End Results (SEER) program information to explore these issues. 3,4,[12][13][14][15][16][17][18] Although SEER data include valuable regional information on a large, geographically diverse population, it lacks detailed information concerning screening mammography use and underlying comorbidities that may impact survival.…”

mentioning

confidence: 99%

Racial and ethnic differences in breast cancer survival

Curtis

Quale

Haggstrom

et al. 2007

168

BACKGROUND. The reasons for race/ethnicity (R/E) differences in breast cancer survival have been difficult to disentangle. METHODS. Surveillance, Epidemiology, and End Results (SEER)‐Medicare data were used to identify 41,020 women aged ≥68 years with incident breast cancer between 1994–1999 including African American (2479), Hispanic (1172), Asian/Pacific Island (1086), and white women (35,878). A Cox proportional hazards model assessed overall and stage‐specific (0/I, II/III, and IV) R/E differences in breast cancer survival after adjusting for mammography screening, tumor characteristics at diagnosis, biologic markers, treatment, comorbidity, and demographics. RESULTS. African American women had worse survival than white women, although controlling for predictor variables reduced this difference among all stage breast cancer (hazards ratio [HR], 1.08; 95% confidence interval [95% CI], 0.97–1.20). Adjustment for predictors reduced, but did not eliminate, disparities in the analysis limited to women diagnosed with stage II/III disease (HR, 1.30; 95% CI, 1.10–1.54). Screening mammography, tumor characteristics at diagnosis, biologic markers, and treatment each produced a similar reduction in HRs for women with stage II/III cancers. Asian and Pacific Island women had better survival than white women before and after accounting for all predictors (adjusted all stages HR, 0.61 [95% CI, 0.47–0.79]; adjusted stage II/III HR, 0.61 [95% CI, 0.47–0.79]). Hispanic women had better survival than white women in all and stage II/III analysis (all stage HR, 0.88; 95% CI, 0.75–1.04) and stage II/III analysis (HR, 0.88; 95% CI, 0.75–1.04), although these findings did not reach statistical significance. There was no significant difference in survival by R/E noted among women diagnosed with stage IV disease. CONCLUSIONS. Predictor variables contribute to, but do not fully explain, R/E differences in breast cancer survival for elderly American women. Future analyses should further investigate the role of biology, demographics, and disparities in quality of care. Cancer 2008. © 2007 American Cancer Society.