Abstract
Background: Breast cancer survival has been shown to be significantly less among black women than white women. The reason for this difference in survival is unclear.
Methods: Data were obtained retrospectively on 439 women seen between 1985 and 1993 based on a detailed chart audit. The impact of race and several known prognostic factors on overall survival, time to relapse, and survival after relapse were studied.
Results: Black women with breast cancer were found to have a greater risk of recurrence, shorter overall survival, and shorter survival after relapse than did white women. Black patients were found to be younger and have higher stage of disease and lower hormone receptor levels than were white patients. After adjustment for menopausal status and disease stage, a significant independent effect of race was observed on overall survival but not risk of recurrence. In multivariate analysis, a significant interaction was observed between race and age in some models. Survival after recurrence of disease was lower among black than white women after adjustment for menopausal status and estrogen receptor level.
Conclusion: Black women experience shorter survival times than do white women, including a shorter survival time after disease recurrence. Breast cancer in black women is associated with younger age, higher stage at presentation, and low hormone receptor levels. After adjustment for known prognostic factors, race remains a significant independent predictor of breast cancer survival.
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References
Wingo PA, Tong T, Bolden S. Cancer statistics, 1995.CA 1995;45:8–30.
Miller BA, Ries LAG, Hankey BF, et al., eds.SEER cancer statistics Review: 1973–1990. Bethesda, MD: National Cancer Institute.
Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer: results of the National Cancer Institute black/white cancer survival study.JAMA 1994;292:947–54.
Hunter CP, Redmond C, Chen VW, et al. Breast cancer: factors associated with stage at diagnosis in black and white women.J Natl Cancer Inst 1993;85:1129–37.
Swanson GM, Lin C-S. Survival patterns among younger women with breast cancer: the effects of age, race, stage and treatment.J Natl Cancer Inst 1994;16:69–77.
Chen F, Trapido EJ, Davis K. Differences in stage at presentation of breast and gynecologic cancers among whites, blacks and Hispanics.Cancer 1994;73:2838–42.
Damsey RD, Hessel PA, Browde S, et al. Lack of a significant independent effect of race on survival in breast cancer.Cancer 1988;61:1908–12.
Elledge RM, Clark GM, Chamness GC, Osborne CK. Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States.J Natl Cancer Inst 1994;86:705–12.
Chen VW, Correa P, Kurman RJ, et al. Histological characteristics of breast carcinoma in blacks and whites.Cancer Epidemiol Biomarkers Prevent 1994;3:127–35.
Reynolds P, Boyd PT, Blacklow RS, et al. The relationship between social ties and survival among black and white breast cancer patients.Cancer Epidemiol Biomarkers Prevent 1994;3:253–9.
Gordon NH, Crowe JP, Brumberg DJ, Berger NA. Socioeconomic factors and race in breast cancer recurrence and survival.Am J Epidemiol 1992;135:609–18.
Gart JJ, Thomas DG. The performance of three approximate confidence limit methods for the odds ratio.Am J Epidemiol 1982;115:453–70.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–81.
Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration.Cancer Chemother Rep 1966;50:163–70.
Peto R, Pike MC, Armitage P, et al. Design and analysis of randomized trials requiring prolonged observation of each patient. II. Analysis and examples.Br J Cancer 1977;35:1–39.
Cox D. Regression models and lifetables.R J Stat Soc 1972;34:187.
Bartolucci AA, Fraser FD. Comparative step-upward composite tests for selecting prognostic indicators associated with survival.Biomet J 1977;19:437–48.
Elias EG, Suter CM, Brown SD, Buda BS, Vachon DA. Survival differences between black and white women with breast cancer.J Surg Oncol 1994;55:37–41.
Gregorio DI, Cummings M, Michalek A. Delay, stage of disease, and survival among white and black women with breast cancer.Am J Public Health 1983;73:590–3.
Moormeier J. Breast cancer in black women.Ann Intern Med 1996;124:897–905.
Jones BA, Kasl SV, Curnen MGM, Owens PH, Dubrow R. Can mammography screening explain the race difference in stage at diagnosis of breast cancer.Cancer 1995;75:2103–13.
Caplan LS, Helzlsouer KJ, Shapiro S, Freedman LS, Coates RJ, Edwards BK. System delay in breast cancer in whites and blacks.Am J Epidemiol 1995;142:804–12.
Cella DF, Orav EJ, Kornblith AB, et al. Socioeconomic status and cancer survival.J Clin Oncol 1991;9:1500–9.
Ansell D, Whitman S, Lipton R, Cooper R. Race, income, and survival from breast cancer at two public hospitals.Cancer 1993;72:2974–8.
Richardson JL, Lanholz B, Bernstein L, Burciaga C, Danley K, Ross RK. Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year.Br J Cancer 1992;65:922–6.
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Lyman, G.H., Kuderer, N.M., Lyman, S.L. et al. Importance of race on breast cancer survival. Annals of Surgical Oncology 4, 80–87 (1997). https://doi.org/10.1007/BF02316814
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DOI: https://doi.org/10.1007/BF02316814