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

Abstract

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

Omission of radiation therapy after breast‐conserving surgery in the United States

“…10 Moreover, other nonrandomized studies have demonstrated similar findings. 18,20 The results from our population-based study are consistent with the ECTCG study. Indeed, our study indicated that increased mortality rates with the omission of RT were observed for all patients regardless of ER status.…”

Targeting Social and Economic Correlates of Cancer Treatment Appointment Keeping among Immigrant Chinese Patients

“…3,[5][6][7] Low rates of cancer treatment appointment keeping, lower rates of receipt of adjuvant therapy, and early treatment termination have been described. 3,[8][9][10][11][12][13][14][15][16][17][18] However, these studies largely focus on black and Hispanic minority populations, with few authors examining disparities in treatment and survival among Asians. There are no studies assessing cancer treatment appointment keeping among Chinese immigrants.…”

Disparities in Oncologic Surgery

“…For example, racial disparities have been documented in rates of surgical resection for breast, esophageal, colorectal, and non-small-cell lung cancer (NSCLC) [1][2][3][4][5]. There are also disparities in the postoperative management of patients, with lower rates of radiation therapy among some demographic groups after breast-conserving surgery (BCS) or resection for rectal cancer [3,6]. Socioeconomic status (SES) has been shown to influence surgical decision making, with lower SES associated with lower rates of BCS and postmastectomy reconstruction for breast cancer, less sphincter-sparing surgery for rectal cancer, and lower rates of staging procedures for NSCLC [2,3,[7][8][9][10][11].…”