Racial differences in breast cancer survival in women under age 60 (original) (raw)
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Race, income, and survival from breast cancer at two public hospitals
Cancer, 1993
Background. Some studies have shown that adjustment for socioeconomic status reduces breast cancer survival differences between blacks and whites. The purpose of this study is to evaluate the effect of age, race, stage, treatment, and income status on breast cancer survival among women attending public hospitals in Chicago, Illinois.
American Journal of Public Health, 2006
Racial and ethnic differences in breast cancer incidence, stage at diagnosis, and mortality have been observed for decades in the United States.'"'' White women have a higher ageadjusted incidence of breast cancer than do Black women, Hispanic women, and otber ethnic groups for whom data are available.''D espite having the highest inddence of breast cancer. White women do not have the highest mortality. The 1998 to 2002 breast cancer mortality rate per 100000 was 26.2 for non-Hispanic White women, 34.7 for Black women, and 16.7 for Hispanic women.^ This suggests tbat, despite their much lower incidence. Black women are more likely to die from breast cancer tban are Wbite women.^"* Of additional concern is that the breast cancer mortality rate for Black women actually rose in tbe late 1990s, at the same time it was declining overall and for White women in particular.''^"Ŵ omen of color are significantly more likely to be diagnosed witb breast cancer at a late stage in the United States.^'^**'" Li et al. reported that Black, American Indian, and Hawaiian women and Hispanic women of Mexiccin, Puerto Rican, and Central and Soutb American descent were all at increased risk of late-stage diagnosis, compared with non-Hispanic White women.** The Black-White disparity is the most prominent, with 34% of White women diagnosed at the regional or metastatic stage, compared with 44% of Black women.T his, however, does not explain all of the Black-Wbite disparity in breast cancer mortality, because even within stage categories. Black women have significantly poorer survival tban do White women.^"^'*'°" Exposure to mammography screening explains some of tbe radal/etbnic disparity in breast cancer stage at diagnosis.'^'^ In Objectives. Previous research has generally found that racial/ethnic differences in breast cancer stage at diagnosis attenuate when measures of socioeconomic status are included in the analysis, although most previous research measured socioeconomic status at the contextual level. This study investigated the relation between race/ethnicity, individual socioeconomic status, and breast cancer stage at diagnosis. Methods. Women with stage 0 to III breast cancer were identified from populationbased data from the Surveillance, Epidemiology, and End Results tumor registries in the Detroit and Los Angeles metropolitan areas. These data were combined with data from a mailed survey in a sample of White, Black, and Hispanic women (n=1700). Logistic regression identified factors associated with early-stage diagnosis. Results. Black and Hispanic women were less likely to be diagnosed with earlystage breast cancer than were White women (P<.001). After control for study site, age, and individual socioeconomic factors, the odds of early detection were still significantly less for Hispanic women (odds ratio [OR]=0.45) and Black women (OR = 0.72) than for White women. After control for the method of disease detection, the White/Black disparity attenuated to insignificance; the decreased likelihood of early detection among Hispanic women remained significant (OR = 0.59). Conclusion. The way in which racial/ethnic minority status and socioeconomic characteristics produce disparities in women's experiences with breast cancer deserves further research and policy attention. {Am
Race and Differences in Breast Cancer Survival in a Managed Care Population
JNCI Journal of the National Cancer Institute, 1999
Background: African-American women with breast cancer have poorer survival than European-American women. After adjustment for socioeconomic variables, survival differences diminish but do not disappear, possibly because of residual differences in health care access, biology, or behavior. This study compared breast cancer survival in African-American and European-American women with similar health care access. Methods: We measured survival in women with breast cancer who are served by a large medical group and a metropolitan Detroit health maintenance organization where screening, diagnosis, treatment, and follow-up are based on standard practices and mammography is a covered benefit. We abstracted data on African-American and European-American women who had been diagnosed with breast cancer from January 1986 through April 1996 (n = 886) and followed these women for survival through April 1997 (137 deaths). Results: African-American women were diagnosed at a later stage than were European-American women. Median follow-up was 50 months. Five-year survival was 77% for African-American and 84% for European-American women. The crude hazard ratio for African-American women relative to European-American women was 1.6 (95% confidence interval [CI] = 1.1-2.2). Adjusting only for stage, the hazard ratio was 1.3 (95% CI = 0.9-1.9). Adjusting only for sociodemographic factors (age, marital status, and income), the hazard ratio was 1.2 (95% CI = 0.8-1.9). After adjusting for age, marital status, income, and stage, the hazard ratio was 1.0 (95% CI = 0.7-1.5). Conclusion: Among women with similar medical care access since before their diagnoses, we found ethnic differ-Affiliations of authors: M. Ulcickas Yood, Josephine Ford
Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage
Journal of Surgical Research, 2009
Background-Black women often present with advanced-stage breast cancer compared with White women, which may result in the observed higher mortality among Black women. Agerelated factors (e.g., comorbidity) also affect mortality. Whether racial disparities in mortality are evident within age and/or stage groups has not been reported, and risk factors for greater mortality among Black women are not well defined. Methods-Using the 1988-2003 Surveillance, Epidemiology, and End Results (SEER) Program data, we conducted a retrospective, population-based cohort study to compare overall and stagespecific breast-cancer mortality between Black and White women within each age (<40, 40-49, 50-64, and 65+) and stage (stage 0-IV and unstaged) group at diagnosis. Cox regression models calculated unadjusted and adjusted hazard ratios (HR) and 95% confidence intervals (CI), the latter controlling for potential confounders of the relationship between race and survival. Results-In the 1988-2003 SEER data, 20,424 Black and 204,506 White women were diagnosed with first primary breast cancer. In unadjusted models, Black women were more likely than White women to die from breast cancer (HR: 1.90, 95% CI: 1.83-1.96) and from all causes (HR: 1.52, 95% CI: 1.48-1.55) during follow-up. In models stratified by age and stage, Black women were at increased risk of breast-cancer-specific mortality within each stage group among women <65 years. Conclusion-Racial disparities in breast-cancer-specific mortality were predominantly observed within each stage at diagnosis among women <65 years old. This greater mortality risk for Black women was largely not observed among women ≥65 years of age.
Socioeconomic factors and breast cancer in black and white Americans
Cancer and Metastasis Reviews - CANCER METAST REV, 2003
The incidence of breast cancer in the US is known to be higher among white than black women and among women of higher socioeconomic status (SES), but once a woman, either black or white, has the disease, she is more likely to have a recurrence and to die of breast cancer if she is of lower socioeconomic status. Explanations for these observed differences are varied and inconsistent making it clear that these reported differentials are not sufficiently understood. In understanding breast cancer in a multicultural setting, delay in diagnosis, follow-up, and treatment are frequently the focus of attention. However these factors do not sufficiently explain the observed differences between blacks and whites. A review of recent literature reveals an increasing focus on the role of SES in breast cancer etiology and progression; however, the confounding of SES with race/ethnicity (black vs. white) contributes to the insufficient understanding of the effect of these two factors. This report ...
Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study
PLOS ONE, 2019
Introduction Differences in breast cancer survival by race and ethnicity are often assumed to be a fairly recent phenomenon, and are hypothesized to have arisen due to gaps in receipt of screening or therapy. The emergence of these differences in calendar time have implications for identification of their origin. We sought to determine whether breast cancer survival differences by race or ethnicity arose in tandem with the advent of screening or therapeutic advances. Materials and methods A cohort of women diagnosed with invasive breast cancer from 1975-2009 in 18 populationbased registries were followed for five-year breast cancer cause-specific survival. Differences in survival according to race/ethnicity and estrogen receptor status were quantified in Cox proportional hazards models, with estimation of hazard ratios (HR), 95% confidence intervals (CI), and absolute risk differences. For 2010, we also assessed differences in survival by breast cancer subtypes defined by hormone receptor and Her2/neu status. Results Among over 930,000 women, initial differences in five-year breast cancer-specific survival by race became apparent among 1975-1979 diagnoses and continued to be evident, with stronger disparities apparent in those of Black vs. White Non-Hispanic (WNH) race and among estrogen-receptor positive vs. negative disease. Within breast cancer subtype, all included race/ethnic groups experienced disparate survival in comparison with WNH women for triple-negative disease. Black women had a consistent gap in absolute survival of .10-.12, compared with WNH women, from 1975-1979 through all included time periods, such that 5-year survival of Black women diagnosed in 2005-09 lagged more than 20 years behind that of WNH women.
Breast cancer is the most common malignancy among women (accounting for approximately 27% of all new noncutaneous cancers in women) and the second most common cause of cancerrelated death among women in the United States. The lifetime occurrence of breast cancer was recently reported as approximately 1 in 8 women. 1 Annual mammographic screening has improved the detection of breast cancer at earlier stages with a concurrent decrease in mortality. 2 Several studies have looked at various factors that might play a potential prognostic role in this disease, including age at diagnosis, histology, and race. All of these factors have been correlated with differences in mortality rates among various population groups.