Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95, 1759-1766

Division of Health Promotion and Education, University of Northern Iowa, Cedar Falls, Iowa 50614-0241, USA.
Cancer (Impact Factor: 4.89). 10/2002; 95(8):1759-66. DOI: 10.1002/cncr.10827
Source: PubMed


African-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.
Subjects 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.
Among 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.
Significant 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.

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    • "Based on the literature, seven biological risk factors are more likely to occur in all women, but in a higher percentage in women of African ancestry. These include the prevalence of ER, PR negative status (Dignam, 2000; Joslyn, 2002), TNBC (Bauer et al., 2007; Lund et al., 2009), and the p53 gene (Dookeran et al., 2010). In addition, being of a young age at diagnosis (Palmer, Wise, & Horton, 2003; Shavers et al., 2003), having an increased BMI (Lu et al., 2011; Sarkissyan, Wu, & Vadgama, 2011), and increased risk of greater parity (Palmer et al., 2011; Palmer et al., 2003) are all contributing factors. "
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