Analysis of prognostic factors in 568 patients treated for breast cancer by surgery

Cancer-specific beliefs and survival: a population-based study of African-American and White breast cancer patients

OBJECTIVE

Beliefs about cancer and its treatment have been shown to influence cancer stage at diagnosis and, thus, prognosis. The association between these beliefs and survival is understudied, especially among racially/ethnically diverse populations. We investigated the relationship between cancer-specific beliefs and survival in a cohort of African-American and White women with newly diagnosed breast cancer followed for up to 15 years.

METHODS

We examined beliefs about cancer detection, treatment, and curability in a population-based cohort of 145 African-American and 177 White women diagnosed with breast cancer in Connecticut, US, between 1987 and 1989. Cox proportional-hazards models were adjusted for stage at diagnosis, other biomedical variables, socio-demographic and lifestyle factors.

RESULTS

In multivariate models, perceived cancer incurability was associated with a higher risk of death from any cause (hazards ratio (HR)=1.67, 95 confidence interval (CI)=1.11, 2.51). Further control for tumor characteristics, genetic alterations, access to care, and additional psychosocial factors did not alter these findings. Other cancer-specific beliefs examined here were not related to survival.

CONCLUSIONS

Perceived cancer incurability is independently associated with survival among breast cancer patients in fully adjusted models. The identification of the underlying mechanisms of this association has potential for translation into intervention strategies for cancer patients.

Prognostic significance of psychosocial factors in African-American and white breast cancer patients: a population-based study

BACKGROUND

It has been suggested that psychosocial factors, such as coping and emotional support, influence cancer survival, but results have been inconclusive. Given the scarce data from racially/ethnically diverse populations, the authors investigated the prognostic significance of selected psychosocial variables in a cohort of African-American women and white women with breast cancer.

METHODS

The authors examined the effects of coping styles, perceived emotional support, fatalism, and health locus of control on survival for a population-based cohort of 145 African-American women and 177 white women who were diagnosed with breast cancer in Connecticut between January 1987 and March 1989 and were followed for survival for approximately 10 years. Cox proportional hazards models were adjusted for sociodemographic factors, biomedical factors (American Joint Committee on Cancer stage at diagnosis, histologic grade, comorbidity, obesity, menopausal status, and treatment), and lifestyle factors.

RESULTS

Fully adjusted models showed that lower perceived emotional support (disagreeing with the statement, "cancer is a topic I can talk about freely with my friends/relatives") at diagnosis was associated with a higher risk of death from any cause (hazard ratio, 1.39; 95% confidence interval, 1.09-1.79). Adjustment for additional tumor characteristics (nuclear grade, estrogen and progesterone receptor status) and genetic alterations (p53, HER-2) did not alter the findings. No other psychosocial factors significantly predicted survival in patients with breast cancer.

CONCLUSIONS

Higher levels of perceived emotional support showed a moderate but significant association with increased survival in African-American and white women with breast cancer who were followed for 10 years after diagnosis when adjusting for known prognostic factors. Survival was not related to coping styles, fatalism, or health locus of control.

Can mammography screening explain the race difference in stage at diagnosis of breast cancer?

BACKGROUND

A race difference in the stage at diagnosis of breast cancer is well established: African American women are less likely than white women to be diagnosed at a localized stage. The purpose of this study was to determine the extent to which the observed race (black/white) difference in stage at diagnosis of breast cancer could be accounted for by race differences in the mammography screening history.

METHODS

This was a population-based, retrospective study of 145 African American and 177 white women with newly diagnosed breast cancer in Connecticut, between January, 1987 and March, 1989. Cases were ascertained through active surveillance of 22 Connecticut hospitals.

RESULTS

Black women were diagnosed more commonly with later stage cancer (TNM stage > or = II) (age-adjusted odds ratio [OR] = 2.01, 95% confidence interval [CI] 1.24-3.24) than were white women. Blacks were also more likely than whites to report that they had not received a mammogram in the 3 years before development of symptoms or diagnosis (OR = 2.05, 95% CI 1.26-3.35); this association was not altered substantially with adjustment for socioeconomic status. In race-specific analyses, mammography was protective against later stage diagnosis in white women, but not in black women. With adjustment for mammography screening, the OR for the race-stage association was reduced only minimally, and race remained a significant predictor of stage at diagnosis.

CONCLUSIONS

In these population-based data, history of mammography screening was not an important explanatory variable in the race-stage association. Specifically, history of mammographic screening accounted for less than 10% of the observed black/white difference in stage at diagnosis of breast cancer.