Race and Differences in Breast Cancer Survival in a Managed Care Population

Yood, Marianne Ulcickas; Johnson, Christine Cole; Blount, Angela; Abrams, Judith; Wolman, Eric; McCarthy, Bruce D.; Raju, Usha; Nathanson, David; Worsham, Maria J.; Wolman, Sandra R.

doi:10.1093/jnci/91.17.1487

Cited by 131 publications

(85 citation statements)

References 27 publications

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“…[23][24][25][26][27][28][29] However, the results of the current study support results of a study by Wojcik et al 30 who reported that survival remains significantly worse for African-American women even with equivalent treatment. In the Wojcik et al study, survival was significantly better for patients who received BCS with radiation therapy than for those who received BCS alone.…”

Section: Discussionsupporting

confidence: 86%

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

Joslyn

2002

Cancer

108

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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

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Section: Discussionsupporting

confidence: 86%

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

Joslyn

2002

Cancer

108

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“…Although biologic and behavioral differences may influence outcomes to some extent, evidence suggests that when women across racial and ethnic groups receive equal treatment, equal outcomes follow [97,98]. Black patients are at no greater risk for chemotherapy-related hematologic toxicity than white patients [99], and clinical trial results suggest that patterns of response to local and systemic therapy are similar for black and white women withclinicallyequivalentdisease[75, 100 -102].Inlightofthisevidence, it is critically important that the health system itself is designed in such a way that all women have access to lifeprolonging cancer treatments, regardless of race, age, or socioeconomic status.…”

Section: Opportunities and Recommendations For Future Researchmentioning

confidence: 99%

Disparities in Breast Cancer Treatment and Outcomes: Biological, Social, and Health System Determinants and Opportunities for Research

2013

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Racial disparities in breast cancer mortality have been widely documented for several decades and persist despite advances in receipt of mammography across racial groups. This persistence leads to questions about the roles of biological, social, and health system determinants of poor outcomes. Cancer outcomes are a function not only of innate biological factors but also of modifiable characteristics of individual behavior and decision making as well as characteristics of patient-health system interaction and the health system itself. Attempts to explain persistent racial disparities have mostly been limited to discussion of differences in insurance coverage, socioeconomic status, tumor stage at diagnosis, comorbidity, and molecular subtype of the tumor. This article summarizes existing literature exploring reasons for racial disparities in breast cancer mortality, with an emphasis on treatment disparities and opportunities for future research. Because breast cancer care requires a high degree of multidisciplinary team collaboration, ensuring that guideline recommended treatment (such as endocrine therapy for hormone receptor positive patients) is received by all racial/ethnic groups is critical and requires coordination across multiple providers and health care settings. Recognition that variation in cancer care quality may be correlated with race (and socioeconomic and health system factors) may assist policy makers in identifying strategies to more equally distribute clinical expertise and health infrastructure across multiple user populations. The Oncologist 2013;18:986 -993 Implications for Practice: Disparities in breast cancer outcomes result not only from racially specific tumor differences, but also modifiable social and health system determinants, such as poor access to care and health education, lack of financial resources, problematic patient-provider interactions, and structural barriers within the health system itself. Breast cancer care requires a high degree of multidisciplinary team collaboration; therefore, ensuring that care is delivered in a coordinated, continuous, culturally and socioeconomically sensitive fashion is critical to ensuring equitable receipt of guideline recommended treatments, which in turn, will help improve outcomes across racial groups. Understanding how biological, social, and health system factors act in concert to influence outcomes may help clinicians, researchers, and policy makers to identify more innovative strategies to address breast cancer disparities going forward.

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“…1,2 Later stage at diagnosis accounts for a significant proportion of the mortality difference, and lower rates of screening mammography account for some of the racial disparities in stage at diagnosis. [3][4][5] Although…”

Section: Interventionmentioning

confidence: 99%

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

Earp

Eng²,

O’Malley³

et al. 2002

Am J Public Health

192

172

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Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older.Methods. A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys.The primary outcome was self-reported mammography use in the previous 2 years.Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = −1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by lowincome women in comparison counties. Adjustment for potentially confounding characteristics did not change the results.Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.

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Race and Differences in Breast Cancer Survival in a Managed Care Population

Abstract: Among women with similar medical care access since before their diagnoses, we found ethnic differences in stage of breast cancer at diagnosis. Adjustment for this difference and for income, age, and marital status resulted in a negligible effect of race on survival.

Cited by 131 publications

References 27 publications

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

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

Disparities in Breast Cancer Treatment and Outcomes: Biological, Social, and Health System Determinants and Opportunities for Research

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

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