Survival Differences in Breast Cancer among Racial/Ethnic Groups: A Population-Based Study

Abstract

In women, breast cancer is the most frequent solid tumor and the second leading cause of cancer death. Differences in survival of breast cancer have been noted among racial/ethnic groups, but the reasons are unclear. This report presents the characteristics and the survival experience of four racial/ethnic groups and evaluates the effects of stage, age, histology, and treatment on survival time. The distributions of prognostic factors and treatment among racial/ethnic groups are compared using female breast cancer patients from two population-based registries in Southern California. The main end points are observed survival time and survival by cause of death. The Cox model is used to estimate the relative risk of death in three minority groups compared with non-Hispanic whites, while controlling for several covariates. Breast cancer cases included in this study were 10,937 non-Hispanic whites, 185 blacks, 875 Hispanics, and 412 Asians. The median follow-up period was 76 months (range: 48-132). The median age at diagnosis was 64 years among non-Hispanic whites, 55 years among Hispanics (p = 0.001), 52 years among blacks (p = 0.001), and 50 years among Asians (p = 0. 001). There was more localized disease among non-Hispanic whites (61. 4%) than among blacks (50.8%) and Hispanics (52.2%), but not compared to Asians (59.7%). After controlling for stage, age, histology, treatment, and registry, overall survival significantly differed between non-Hispanic whites and blacks [relative risk (RR) = 2.27, 95% confidence interval (95% CI) 1.82-2.84) and between non-Hispanic whites and Hispanics (RR = 1.18, 95% CI 1.04-1.34). The same results were found for breast cancer death in blacks (RR = 2.32, 95% CI 1.76-3.07) and Hispanics (RR = 1.28, 95% CI 1.10-1.50). We found no difference between Asians and non-Hispanic whites in overall and cancer-related survival. These results show that stage of disease, age at diagnosis, histologic features and treatment for breast cancer differed among racial/ethnic groups. Moreover, black women, in particular, and Hispanic women with breast cancer had a higher risk of death compared to non-Hispanic white women, even after controlling for prognostic factors. These findings underline the necessity of improved screening and access to appropriate treatment among minority women for breast cancer.

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

“…[5][6][7][8][9][10][11] One of the reasons for these disparities in breast cancer outcomes is the well-documented tendency toward later stage at diagnosis among women of lower socioeconomic status (SES) and women of color. 5,8,9,[12][13][14] Differences in mammography utilization are widely believed to contribute to observed socioeconomic and racial/ethnic variation in prevalence of late-stage diagnosis. Despite recommendations for routine annual or biannual mammography for all women age 40 years and older, significant gaps exist in uptake across population subgroups.…”

Socioeconomic status and breast carcinoma survival in four racial/ethnic groups

“…5,6,12 Although the black/white survival disparity in breast carcinoma is well documented, few studies of racial/ethnic disparities have addressed the survival experience of other racial/ethnic groups. Like black women, Hispanic women also tend to be diagnosed with breast carcinoma at a later stage than white women, but it is unclear if Hispanic females have poorer survival.…”

“…Like black women, Hispanic women also tend to be diagnosed with breast carcinoma at a later stage than white women, but it is unclear if Hispanic females have poorer survival. 9,[12][13][14][15] International studies of breast carcinoma have shown better survival for Japanese than Caucasians, 16 but most studies report similar survival rates for Asians and whites within the United States. 12,[17][18][19] In addition, although race/ethnicity, disease stage, and SES are correlated, SES measures have not been included in most studies of Asian and Hispanic women.…”

Prognostic significance of microvessel density and other variables in Japanese and British patients with primary invasive breast cancer

“…In contrast, patients with ER-negative tumours are often given chemotherapy. Boyer-Chammard et al (1999) reported that African-American, Hispanic, and Asian patients with breast cancer from 1984 through 1990 were more likely than Caucasian patients to receive chemotherapy and less likely to receive endocrine therapy. The current study is similar to those results.…”

“…Asian-American and Japanese patients tend to have a lower incidence of breast cancer and have a better prognosis than Caucasians (Yonemoto, 1980;Sakamoto et al, 1981;Natarajan et al, 1988;Tominaga and Kuroishi, 1995;Boyer-Chammard et al, 1999;Braun et al, 2004). Age-adjusted incidence rate for breast cancer among Japanese patients has markedly increased 1.9-fold from 1978 to 1998 (age-adjusted incidence rate: 17.9, 33.8, respectively) (The Research Group for Population-based Cancer Registration in Japan, 1999Japan, , 2003Tamakoshi et al, 2005) and age-adjusted death rate has increased moderately (Tominaga and Kuroishi, 1995), but is still much lower compared with those of Caucasians (Tominaga and Kuroishi, 1995;Kawamura and Sobue, 2005).…”