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Donkers H, Bekkers R, Massuger L, Galaal K. Systematic review on socioeconomic deprivation and survival in endometrial cancer. Cancer Causes Control 2019; 30:1013-1022. [DOI: 10.1007/s10552-019-01202-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/25/2019] [Indexed: 01/19/2023]
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Cushman TR, Haque W, Menon H, Rusthoven CG, Butler EB, Teh BS, Verma V. Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion. J Gynecol Oncol 2018; 29:e97. [PMID: 30207105 PMCID: PMC6189436 DOI: 10.3802/jgo.2018.29.e97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods The National Cancer Database was queried for patients ≥70 years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.
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Affiliation(s)
- Taylor R Cushman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Hari Menon
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, CO, USA
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.
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Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 PMCID: PMC6598506 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
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Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Ghia AJ, Neeley ES, Gaffney DK. Postoperative radiotherapy use and patterns of care analysis for node positive or parametria positive cervical cancer. Gynecol Oncol 2010; 119:411-6. [DOI: 10.1016/j.ygyno.2010.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 07/06/2010] [Accepted: 07/11/2010] [Indexed: 11/29/2022]
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Soler-Vilá H, Dubrow R, Franco VI, Kasl SV, Jones BA. The prognostic role of cancer-specific beliefs among prostate cancer survivors. Cancer Causes Control 2010; 22:251-60. [PMID: 21113652 DOI: 10.1007/s10552-010-9693-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 11/08/2010] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study is to evaluate the association between cancer-specific beliefs and survival among men newly diagnosed with prostate cancer. METHODS Based on data from a biracial cohort monitored for mortality for up to 15 years, we investigated the association between beliefs and survival among 251 men newly diagnosed with prostate cancer between 1987 and 1990. We examined patients' beliefs related to efficacy of regular checkups for detection, potential negative treatment effects, and perceived curability of cancer. Cox proportional hazards models were adjusted for sociodemographic variables, medical care measures, clinical factors, and lifestyle. RESULTS In a fully adjusted model, not believing that most cancers can be cured was associated with an increased risk of death from any cause (Hazard Ratio = 1.62; 95% confidence interval = 1.11, 2.38). Beliefs regarding the efficacy of checkups or potential negative treatment effects were not associated with survival. CONCLUSIONS Prostate cancer patients who reported not believing that most cancers are curable experienced poorer survival after adjusting for a wide array of prognostic factors and potential confounders. Future research to identify underlying behavioral (medical protocol adherence, lifestyle) and physiological (immune and endocrine regulation) mechanisms of this association would translate into improved intervention strategies for cancer survivors.
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Affiliation(s)
- Hosanna Soler-Vilá
- Department of Epidemiology, Public Health and Sylvester Comprehensive Cancer Center, University of Miami, FL 33136, USA.
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6
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Sprague BL, Trentham-Dietz A, Gangnon RE, Ramchandani R, Hampton JM, Robert SA, Remington PL, Newcomb PA. Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer 2010; 117:1542-51. [PMID: 21425155 DOI: 10.1002/cncr.25589] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/28/2010] [Accepted: 07/20/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women who live in geographic areas with high poverty rates and low levels of education experience poorer survival after a breast cancer diagnosis than women who live in communities with indicators of high socioeconomic status (SES). However, very few studies have examined individual-level SES in relation to breast cancer survival or have assessed the contextual role of community-level SES independent of individual-level SES. METHODS The authors of this report examined both individual-level and community-level SES in relation to breast cancer survival in a population-based cohort of women ages 20 to 69 years who were diagnosed with breast cancer in Wisconsin between 1995 and 2003 (N = 5820). RESULTS Compared with college graduates, women who had no education beyond high school were 1.39 times more likely (95% confidence interval [CI], 1.10-1.76) to die from breast cancer. Women who had household incomes <2.5 times the poverty level were 1.46 times more likely (95% CI, 1.10-1.92) to die from breast cancer than women who had household incomes ≥5 times the poverty level. Adjusting the analysis for use of screening mammography, disease stage at diagnosis, and lifestyle factors eliminated the disparity by income, but the disparity by education persisted (hazard ratio [HR], 1.27; 95% CI, 0.99-1.61). In multilevel analyses, low community-level education was associated with increased breast cancer mortality even after adjusting for individual-level SES (HR, 1.57; 95% CI, 1.09-2.27 for ≥20% vs <10% of adults without a high school degree). CONCLUSIONS The current results indicated that screening and early detection explain some of the disparity according to SES, but further research will be needed to understand the additional ways in which individual-level and community-level education are associated with survival.
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Affiliation(s)
- Brian L Sprague
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA.
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Coker AL, Desimone CP, Eggleston KS, White AL, Williams M. Ethnic disparities in cervical cancer survival among Texas women. J Womens Health (Larchmt) 2010; 18:1577-83. [PMID: 19788363 DOI: 10.1089/jwh.2008.1342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this work was to determine whether minority women are more likely to die of cervical cancer. A population-based cohort study was performed using Texas Cancer Registry (TCR) data from 1998 to 2002. METHODS A total of 5,166 women with cervical cancer were identified during 1998-2002 through the TCR. Measures of socioeconomic status (SES) and urbanization were created using census block group-level data. Multilevel logistic regression was used to calculate the odds of dying from cervical cancer by race, and Cox proportional hazards modeling was used for cervical cancer-specific survival analysis. RESULTS After adjusting for age, SES, urbanization, stage, cell type, and treatment, Hispanic women were significantly less likely than non-Hispanic White women to die from cervical cancer (adjusted hazard ratio [aHR] = 0.69; 95% CI [confidence interval] = 0.59-0.80), whereas Black women were more likely to die (aHR = 1.26; 95% CI = 1.06-1.50). Black and Hispanic women were more likely to be diagnosed at a later stage than White women. Black women were significantly less likely to receive surgery among those diagnosed with localized disease (p = 0.001) relative to both White and Hispanic women. CONCLUSIONS Relative to non-Hispanic White women, Black women were more likely to die of cervical cancer while Hispanic women were less likely to die; these survival differences were not explained by SES, urbanization, age, cell type, stage at diagnosis, or treatment.
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Affiliation(s)
- Ann L Coker
- Department of Obstetrics and Gynecology, Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky 40536-0293, USA.
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McKenzie F, Jeffreys M. Do lifestyle or social factors explain ethnic/racial inequalities in breast cancer survival? Epidemiol Rev 2009; 31:52-66. [PMID: 19675112 DOI: 10.1093/epirev/mxp007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite numerous studies documenting ethnic inequalities in breast cancer survival between minority and majority ethnic groups worldwide, reasons for these inequalities remain unclear. The authors performed a systematic review of published literature to identify studies that investigated the explanatory power of smoking, alcohol consumption, body mass index (BMI), and socioeconomic position (SEP) on ethnic inequalities in breast cancer survival. Sixteen studies were included in the review. From 5 studies, the authors found that differences in breast cancer survival between ethnic groups may be in part explained by BMI, but there was little evidence to implicate smoking or alcohol consumption as explanatory factors of this inequality. From 12 studies, the authors found that SEP explains part of the ethnic inequality in all-cause survival but that it was not evident for breast-cancer-specific survival. SEP explains more of the disparities among African-American versus white women in the United States compared with other ethnic comparisons. Furthermore, given social patterning of BMI and other lifestyle habits, it is possible that results for SEP and BMI are measuring the same effect. In this review, the authors make suggestions regarding the role of epidemiology in facilitating further research to better inform the development of effective policies to address ethnic differences in survival.
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Affiliation(s)
- Fiona McKenzie
- Centre for Public Health Research, Massey University, Wellington, New Zealand.
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Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, Micheli A, Sant M, Weir HK, Elwood JM, Tsukuma H, Koifman S, e Silva GA, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 2008; 9:730-56. [PMID: 18639491 DOI: 10.1016/s1470-2045(08)70179-7] [Citation(s) in RCA: 816] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Movva S, Noone AM, Banerjee M, Patel DA, Schwartz K, Yee CL, Simon MS. Racial differences in cervical cancer survival in the Detroit metropolitan area. Cancer 2008; 112:1264-71. [PMID: 18257090 DOI: 10.1002/cncr.23310] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer. METHODS One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment. RESULTS AA women were more likely to present at an older age (P<.001), with later stage disease (P<.001), and with squamous histology (P=.01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P<.001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P=.05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years. CONCLUSIONS In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer.
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Affiliation(s)
- Sujana Movva
- Department of Internal Medicine, Mclaren Regional Medical Center, Michigan State University, Flint, Michigan, USA
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11
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Eggleston KS, Coker AL, Williams M, Tortolero-Luna G, Martin JB, Tortolero SR. Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001. J Womens Health (Larchmt) 2007; 15:941-51. [PMID: 17087618 DOI: 10.1089/jwh.2006.15.941] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis. METHODS Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR = 6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR = 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR = 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race. CONCLUSIONS SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival.
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Affiliation(s)
- Katherine S Eggleston
- School of Public Health, University of Texas Health Science Center, Houston, Texas 77225, USA.
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12
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Ueda K, Kawachi I, Tsukuma H. Cervical and corpus cancer survival disparities by socioeconomic status in a metropolitan area of Japan. Cancer Sci 2006; 97:283-91. [PMID: 16630120 PMCID: PMC11158084 DOI: 10.1111/j.1349-7006.2006.00179.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to analyze socioeconomic differences in cervical and corpus cancer survival, and to investigate if the differences are due to differences in age, cancer stage, histology and treatment. A total of 14,055 cases with cervical cancer and 3,113 cases with corpus cancer were obtained from the Osaka Cancer Registry. Municipality-based SES measurements were obtained from the System of Social and Demographic Statistics. Survival analysis was carried out with Kaplan-Meier survival curves. Three types of Cox proportional hazards regression models were tested to assess survival differences among groups and effects of SES on survival, controlling for clinical factors. SES was related to age and cancer stage for cervical and corpus cancer patients, and histology for cervical cancer patients. Differences were observed in cumulative 5-year survival for cervical cancer patients among low, middle and high unemployment municipalities (68.9%, 64.3% and 50.9%, respectively, P<0.0001). Differences in cumulative 5-year survival for cervical cancer patients were also observed among high, middle and low education municipalities (65.1%, 62.2% and 56.1%, respectively, P<0.0001). Similar patterns in 5-year survival were also found for corpus cancer patients. After adjusting for age, cancer stage, histology and treatment, survival differences between patients from high and low SES areas still remained. In conclusion, our population-based analysis of a metropolitan representative sample in Japan has demonstrated, for the first time in Japan, SES differences in survival following cervical and corpus cancer.
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Affiliation(s)
- Kimiko Ueda
- Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. kueda@xb4,so-net.ne.jp
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Zenk SN, Tarlov E, Sun J. Spatial equity in facilities providing low- or no-fee screening mammography in Chicago neighborhoods. J Urban Health 2006; 83:195-210. [PMID: 16736369 PMCID: PMC2527168 DOI: 10.1007/s11524-005-9023-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low- or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African-Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low- or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures-distance and public transportation travel time-is less strong in African-American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African-American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African-American residents. Thus, it appears that the spatial accessibility of low- and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.
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Affiliation(s)
- Shannon N Zenk
- Program in Cancer Control and Population Sciences, University of Illinois at Chicago, Chicago, IL, 60608, USA.
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Robsahm TE, Tretli S. Weak associations between sociodemographic factors and breast cancer: possible effects of early detection. Eur J Cancer Prev 2005; 14:7-12. [PMID: 15677890 DOI: 10.1097/00008469-200502000-00002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Differences in incidence and survival of breast cancer have been observed to vary with regard to sociodemographic factors. This might be related to variation in frequency of doctor consultation and in time of diagnosis, since sociodemographic factors appear to influence the individual's attention to cancer symptoms and susceptibility to participate in screening programmes. This study aimed to examine the variation in breast cancer incidence and case fatality in sociodemographic groups in Norway, and to discuss whether any variation can result from temporal variation in detection time. The study included 589 521 women with information on residential history, childbearing pattern, educational level and occupational physical activity. Analyses were conducted using Poisson and Cox regression models. Although all the associations were weak, breast cancer incidence was associated with residence in urban areas, high age at first childbirth and high level of education. The urban women also tended to have better survival compared with the rural women. Childlessness was associated with high incidence and high case fatality. A high educational level was associated with the lowest case fatality. This study may emphasize the importance of discussing potential effects of early cancer detection. This is particularly important in epidemiological studies revealing weak associations between sociodemographic factors and breast cancer. Mortality rates may be less influenced by problems associated with early detection and, thus, analyses of breast cancer-specific mortality could give additional information.
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Affiliation(s)
- T E Robsahm
- The Cancer Registry of Norway, Institute of Population-Based Cancer Research, Montebello, 0310 Oslo, Norway.
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Abstract
BACKGROUND The current article examined survival for adults < 65 years old diagnosed with breast, colorectal, or lung carcinoma who were either Medicaid insured at the time of diagnosis, Medicaid insured after diagnosis, or non-Medicaid insured. METHODS The authors hypothesized that subjects enrolling in Medicaid after they were diagnosed with cancer would explain disparate survival outcomes between Medicaid and non-Medicaid-insured subjects. The authors used the Michigan Tumor Registry, a population-based cancer registry covering the State of Michigan, to identify subjects who were diagnosed with the cancer sites of interest (n = 13,740). The primary outcome was all cause mortality over an 8-year time period. RESULTS Subjects who enrolled in Medicaid after diagnosis with cancer had much lower 8-year survival rates relative to Medicaid-enrolled and non-Medicaid subjects. These reductions in survival were partly due to a high proportion of lung carcinoma and late-stage cancers within the sample of subjects who enrolled in Medicaid after diagnosis. The likelihood of death was two to three times greater for subjects enrolled in Medicaid relative to subjects who were not enrolled in Medicaid once the analysis was stratified by cancer site and stage. CONCLUSIONS Disparities in cancer survival were apparent between subjects enrolled in Medicaid and subjects not enrolled in Medicaid. From a policy perspective, cancer survival in the Medicaid population cannot be improved as long as 40% of the population enrolls in Medicaid after diagnosis with late-stage disease.
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Affiliation(s)
- Cathy J Bradley
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Lagerlund M, Bellocco R, Karlsson P, Tejler G, Lambe M. Socio-economic factors and breast cancer survival – a population-based cohort study (Sweden). Cancer Causes Control 2005; 16:419-30. [PMID: 15953984 DOI: 10.1007/s10552-004-6255-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Accepted: 11/15/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the influence of socio-economic factors on breast cancer survival in Sweden, a country with population-based mammography screening and a uniform health care system aiming to provide care to all on equal terms. METHODS All women with a first diagnosis of invasive breast cancer in Sweden in 1993 were identified in the Swedish Cancer Register. Their sociodemographic characteristics were determined by record linkages to the 1970, 1980, 1985 and 1990 Census databases, and a nationwide Fertility Register. Information on tumor characteristics at diagnosis was obtained from five Swedish Regional Cancer Registers. Survival status on 31 December 1998, was assessed through follow-up in the Swedish Cause of Death Register. RESULTS Of totally 4645 eligible women diagnosed with breast cancer in 1993, 772 had died from breast cancer through 1998. After adjustment for tumor characteristics and age, risk of death was 37 higher among women of low compared to high socio-economic status (HR high vs. low 0.73; 95 CI: 0.54-0.99). This difference was most pronounced in women less than 50 years at diagnosis. CONCLUSIONS These results show that socio-economic disparities in breast cancer survival prevail even in this relatively homogenous society, offering outreach mammography and standardised treatment regimens in a tax-funded health care system.
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Affiliation(s)
- Magdalena Lagerlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77 Stockholm, Sweden.
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Yabroff KR, Gordis L. Does stage at diagnosis influence the observed relationship between socioeconomic status and breast cancer incidence, case-fatality, and mortality? Soc Sci Med 2004; 57:2265-79. [PMID: 14572836 DOI: 10.1016/s0277-9536(03)00100-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Historically, lower socioeconomic status (SES) has been reported to be associated with decreased breast cancer incidence and mortality and increased case-fatality, although recent trends in breast cancer screening and treatment may alter these relationships. This study assessed the associations between SES and breast cancer incidence, case-fatality, and mortality by stage of disease at diagnosis using recent data in the United States. Breast cancer incidence and survival data from the Surveillance, Epidemiology, and End Results (SEER) tumor registry for black and white women aged 55 and above were linked to county level SES and population data based on place of residence. Poisson regression was used to calculate age-adjusted relative rates associated with SES levels and breast cancer incidence, case-fatality, and mortality. As SES decreased, localized breast cancer incidence rates decreased, while incidence rates of distant disease increased. Five-year localized and regional breast cancer case-fatality rates increased as SES decreased. Localized breast cancer mortality rates decreased as SES declined, whereas regional breast cancer mortality rates tended to increase. These results confirm some previously reported findings and suggest that associations between lower SES and lower localized breast cancer mortality rates are influenced mainly by underlying associations between SES and localized breast cancer incidence, whereas regional breast cancer mortality rates appear to reflect the underlying association between SES and regional case-fatality rates.
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Affiliation(s)
- K Robin Yabroff
- Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
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Chu KC, Lamar CA, Freeman HP. Racial disparities in breast carcinoma survival rates: seperating factors that affect diagnosis from factors that affect treatment. Cancer 2003; 97:2853-60. [PMID: 12767100 DOI: 10.1002/cncr.11411] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Black females have lower breast carcinoma survival rates compared with white females. One possible reason is that black females have more advanced-stage breast disease. Another factor may be racial differences in the utilization of cancer treatments. METHODS The authors determined racial differences in 6-year stage specific survival rates, adjusting for age and treatments (using estrogen receptor [ER] status), to determine whether there were racial differences in treatment. Racial differences in the stage distributions of breast disease were used to examine the impact of racial factors on breast carcinoma diagnosis. RESULTS For all breast carcinoma cases, the stage specific 6-year survival rates, in general, were significantly lower for black females for all stages combined and for Stages I-III in every age group. However, examination by different treatments, as measured by ER status, revealed some different results. Only black women younger than age 50 years with ER-positive tumors and women younger than age 65 years with ER-negative tumors had significantly lower stage-specific survival rates. In addition, the stage distribution analyses showed that black females of every age group had less Stage I breast disease. CONCLUSIONS For younger black women (younger than age 50 years), there was evidence of racial differences in treatment for both women with ER-positive tumors and women with ER-negative tumors, as indicated by their lower stage-specific survival rates. In contrast, for black females age 65 years or older with ER-positive or ER-negative tumors, the lack of a significant difference in the stage-specific survival rate suggests that Medicare may help to alleviate racial disparities in cancer treatment. Furthermore, racial differences in the stage distributions indicated the need for earlier diagnosis for black females of every age.
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Affiliation(s)
- Kenneth C Chu
- Center to Reduce Cancer Health Disparities, National Cancer Institute, Bethesda, Maryland 20892, USA.
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Turner-Cobb JM. Psychological and neuroendocrine correlates of disease progression. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2003; 52:353-81. [PMID: 12498111 DOI: 10.1016/s0074-7742(02)52016-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Julie M Turner-Cobb
- Department of Psychology, University of Kent at Canterbury, Canterbury, Kent CT2 7NP, United Kingdom
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Newman LA, Mason J, Cote D, Vin Y, Carolin K, Bouwman D, Colditz GA. African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast. Cancer 2002; 94:2844-54. [PMID: 12115371 DOI: 10.1002/cncr.10575] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND African-American women are at increased risk for breast cancer mortality compared with white American women, and the extent to which socioeconomic factors account for this outcome disparity is unclear. METHODS A MEDLINE search was conducted to identify published studies that used a Cox proportional hazards regression model to evaluate the outcome of African-American women and white American women with breast carcinoma after adjusting for socioeconomic status. A meta-analysis was performed using specialized statistical software; the random-effects method of statistical evaluation was used because of the a priori impression that the studies reviewed would be at least moderately heterogeneous in study design and patient populations. RESULTS The initial literature search yielded 3962 studies. Fourteen studies met all criteria for inclusion in the meta-analysis, resulting in a sample size of 10,001 African-American patients and 42,473 white American patients with breast carcinoma. There was substantial variation in the method used for defining socioeconomic status. Summary statistics revealed a significant odds ratio of 1.22 (95% confidence interval, 1.13-1.30) for the adverse effect of African-American ethnicity on breast cancer mortality. Subset meta-analyses yielded similar results, supporting the robustness of this finding. CONCLUSIONS This meta-analysis revealed that African-American ethnicity is an independent predictor of a worse breast cancer outcome. The pooled analysis has added strength because of the aggregate sample size and indicates that the true biologic and/or therapeutic determinants of disparities in breast cancer outcome for different ethnic groups and for different socioeconomic strata are incompletely understood.
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Affiliation(s)
- Lisa A Newman
- Karmanos Cancer Institute and Wayne State University, Detroit, Michigan 48201, USA.
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21
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English WP, Cleveland KE, Barber WH. There is no Difference in Survival between African-American and White Women with Breast Cancer. Am Surg 2002. [DOI: 10.1177/000313480206800617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A difference in survival by race in women with breast cancer has been reported. We examined survival of African-American (AA) and white (W) women diagnosed with breast cancer and evaluated variables that may affect survival at a university teaching hospital. A retrospective review of tumor registry data for breast cancer was performed in all AA and W female breast cancer patients diagnosed between the years 1990 and 1999 at a university hospital. Survival between AA and W women diagnosed with breast cancer during that period was compared using Kaplan-Meier analysis. Variables including age and stage of disease at diagnosis, receptor status, treatment, and tobacco exposure were evaluated utilizing Chi-square testing. A P value <0.05 was considered statistically significant. A total of 585 AA and W women were diagnosed with breast cancers between the years 1990 and 1999. Mean ages were 51.8 years for AA and 56.9 years for W ( P = 0.001). Overall survival (7.8 years AA and 7.6 years W) and survival by stage were not statistically different between the groups. AA patients were younger ( P = 0.001), presented with higher-stage tumors ( P = 0.017), more often had positive axillary lymph nodes ( P = 0.012), more often were estrogen and progesterone receptor negative ( P = 0.004), and more often were premenopausal ( P = 0.048). AA women were more likely treated with chemotherapy while W women tended to receive hormone therapy ( P = 0.01). Statistical significance was not reached for differences in tumor histology or tobacco exposure. We conclude that despite presenting with worse prognostic indicators AA women experience survival equivalent to their W counterparts.
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Affiliation(s)
- William P. English
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Kenneth E. Cleveland
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - W. Henry Barber
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
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22
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Joslyn SA. Hormone receptors in breast cancer: racial differences in distribution and survival. Breast Cancer Res Treat 2002; 73:45-59. [PMID: 12083631 DOI: 10.1023/a:1015220420400] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to describe hormone receptor status and analyze the effect of receptors on survival from breast cancer. Comparisons were made between African-American and Caucasian racial categories. Breast cancer data from 1990 through 1997 collected by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program were analyzed. Subjects were 993 Caucasian men, 12,303 African-American women, and 141,045 Caucasian women. The number of African-American men was too small to analyze separately (n = 93). In addition to analysis of estrogen and progesterone receptor status by sex and race, tumor and patient characteristics included age, stage at time of diagnosis, and tumor histology. The proportion of Caucasian men with hormone receptor positive tumors remained relatively high and stable for all ages. In women, the proportion of hormone receptor positive tumors increased with age, with African-American women having the highest proportion of hormone receptor negative tumors. Caucasian men had highest proportions of hormone receptor positive tumors in all histology and stage groups, while African-American women had lowest proportions of hormone receptor positive tumors in all stage and histologic categories. Survival for African-American women was significantly worse for each hormone receptor category. In multivariate analyses, race was a significant independent predictor of survival, but sex was not. Although reasons for differences in hormone receptor status by sex and race are unknown, several hypotheses are discussed with respect to differences in tumor histopathology and risk factors.
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Affiliation(s)
- Sue A Joslyn
- Department of Internal Medicine, The University of Iowa, Iowa City 52246, USA.
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Lin SS, Clarke CA, Prehn AW, Glaser SL, West DW, O'Malley CD. Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas. Cancer 2002. [DOI: 10.1002/cncr.10319] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Behbakht K, Abu-Rustum NR, Lee S, San Juan A, Massad LS. Characteristics and survival of cervical cancer patients managed at adjacent urban public and university medical centers. Gynecol Oncol 2001; 81:40-6. [PMID: 11277647 DOI: 10.1006/gyno.2000.6096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goal of this work was to compare characteristics and survival of cervical cancer patients at adjacent public and university hospitals to define the effects of poverty and ethnicity on disease. METHODS A retrospective chart review was conducted of cervical cancer patients managed by gynecologic oncologists at two adjacent urban hospitals between 1992 and 1998. Continuous variables were compared by t test, categorical variables by chi(2), and survival by the Kaplan-Meier and log-rank methods. RESULTS In all, 372 patients were identified, with 209 (56%) at the public hospital and 163 (44%) at the adjacent university hospital. Ethnic distribution differed between the two hospitals: 100 (52%) versus 46 (28%) African-American, 56 (29%) versus 13 (8%) Hispanic, 31 (16%) versus 96 (60%) Caucasian, and 5 (3%) versus 6 (4%) other (P < 0.001). In addition, public hospital patients presented with more advanced cancers (stages II--IV) than those managed at the university hospital, 96 (48%) versus 53 (34%) (P = 0.008), and squamous cancers were more common at the public hospital, 154 (89%) versus 120 (76%) (P = 0.03). However, with a median follow-up of 17 months, stage-adjusted survival did not differ between the two institutions. CONCLUSIONS The higher proportions of advanced and squamous cervical cancers encountered at the public hospital likely reflect suboptimal screening. Equal access to gynecologic oncologists eliminated disparities in stage-adjusted survival. Efforts at earlier diagnosis should be directed at indigent, especially minority women.
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Affiliation(s)
- K Behbakht
- Department of Obstetrics and Gynecology, Rush--Presbyterian--St. Luke's Medical Center, Chicago, Illinois 60612, USA
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Abstract
Breast carcinoma is the most common cancer in women in the U.S. and the second leading cause of cancer death in women. Furthermore, there are racial differences in breast carcinoma incidence, mortality, and survival rates. Social and economic factors within racial/ethnic groups are being examined as risk factors not only for breast carcinoma mortality and survival but also as determinants of the rate of incidence. Social and economic factors have been associated in the literature predominantly with cancer mortality and survival. When socioeconomic status (SES) is considered, certain studies suggest that racial disparities in breast carcinoma are smaller than when social and economic factors are examined alone, but these disparities still persist. Sources of data for this discussion include the National Cancer Institute (NCI) (the Surveillance, Epidemiology, and End Results [SEER] program, a group of population-based cancer registries that cover up to 14% of the U.S. population. SEER reports cancer incidence, mortality, and survival rates), the U.S. Bureau of the Census, the National Center for Health Statistics (NCHS), and numerous articles from the scientific literature. Socioeconomic factors or SES can be considered "cross-cutting risk factors" (i.e., they can be related to the risk of developing breast carcinoma [rate of incidence] as well as to the risk of dying [mortality] from this disease). They also are the risk factors that "cut across" racial and ethnic populations. Socioeconomic factors are related to breast carcinoma mortality and survival rates in multicultural women. Racial disparities in breast carcinoma mortality and survival rates can be explained partially by stage distribution at the time of diagnosis, which may be related to SES. For example, African-American women present with more advanced stage distributions for breast carcinoma than white women. Similarly, women of lower SES present with higher stage disease than women of upper SES who present with more localized breast carcinoma. The lack of data regarding the SES of cancer patients limits our understanding of the contributions of SES to cancer incidence and mortality rates. SES appears to be related to breast carcinoma incidence, mortality, and survival rates. Breast carcinoma mortality is higher in women of lower SES. Additional research on SES, race, culture, and the relation of these factors to cancer incidence rate is needed.
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Affiliation(s)
- C R Baquet
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Abstract
BACKGROUND Survival after breast carcinoma diagnosis is significantly worse among African American women for reasons unknown. The purpose of this study was to update reports on the National Surveillance, Epidemiology, and End Results Program and to examine the effect of race on breast carcinoma survival. METHODS Subjects were 135,424 women diagnosed with primary breast carcinoma between 1988-1995. Patient age, tumor stage at the time of diagnosis, hormone receptor status, tumor histology, menopausal status, and survival were compared by race category. RESULTS African American women diagnosed with breast carcinoma (n = 11,159) had a significantly increased risk of death from breast carcinoma and from all cancers compared with white women (n = 124,265), independent of the effects of other predictor variables. African American women were significantly younger at the time of diagnosis, with approximately 33% of the population age </= 50 years, compared with slightly <25% of the white women belonging to that younger age group. African American women were significantly more likely to present with advanced stages of breast carcinoma and, within each stage category, had significantly poorer survival compared with white women. African American women were significantly less likely to have tumors positive for estrogen or progesterone receptors, as well as histologically confirmed lobular and tubular carcinomas, whereas they were more likely to have inflammatory, medullary, and papillary histology compared with white women. CONCLUSIONS The results of the current study show that race is an independent predictor of survival from breast carcinoma. These findings are consistent with other large, population-based studies of racial differences in breast carcinoma survival and have been comported by studies of racial differences in the molecular biology of breast carcinoma, thus providing support for the epidemiologic credibility of the independence of the association.
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Affiliation(s)
- S A Joslyn
- University of Northern Iowa, Cedar Falls, Iowa 50614-0241, USA
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