JAMA
1994 Sep 28;272(12):947-54
Comment in:
JAMA. 1995 Apr 5;273(13):1000.
Racial differences in survival from breast cancer. Results of the National
Cancer Institute Black/White Cancer Survival Study.
Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN, Muss HB, Greenberg RS,
Coates RJ, Correa P, Redmond CK, et al.
Division of Epidemiology, Emory University School of Public Health, Atlanta,
GA 30322.
OBJECTIVE: To examine the ability of recognized prognostic
factors for breast cancer to account for the observed poorer survival
in blacks compared with their white counterparts.
DESIGN AND PARTICIPANTS: Subjects included 1130 women
(612 blacks and 518 whites) aged 20 to 79 years residing in metropolitan
Atlanta, Ga, New Orleans, La, or San Francisco/Oakland, Calif, who were
diagnosed with primary invasive breast cancer. Information on stage, tumor
characteristics, treatment, comorbid conditions, and sociodemographic
factors was obtained from personal interview, physician and hospital records,
and a pathology review of biopsy and surgical specimens.
MAIN OUTCOME MEASURE: Multivariable survival models were
used to estimate the hazard ratio (relative risk of mortality) for blacks
compared with whites, adjusting for various combinations of potential
explanatory factors.
RESULTS: After controlling for geographic site and age,
the risk of dying was 2.2 times (95% confidence interval [CI], 1.8 to
2.8) greater for blacks than whites. Adjustment for stage reduced the
risk from 2.2 to 1.7; further adjustment for sociodemographic variables
had no effect. Treatment was not a contributing factor once stage and
tumor pathology were in the model. After adjusting for stage, treatment,
comorbid illness, and pathologic and sociodemographic variables, blacks
continued to demonstrate a slightly increased, but not statistically significant,
risk of death (hazard ratio = 1.3; 95% CI, 1.0 to 1.8). Results were similar
for all-cause mortality and breast cancer-specific mortality.
CONCLUSIONS: Approximately 75% of the racial difference
in survival was explained by the prognostic factors studied. Sociodemographic
variables appeared to act largely through racial differences in stage
at diagnosis, which may be amenable to change through improved access
to and use of screening for black women.
PMID: 8084062 [PubMed - indexed for MEDLINE]
JAMA 1995 Apr 5;273(13):1000
Comment on:
JAMA. 1994 Sep 28;272(12):947-54.
Racial differences in survival from breast cancer.
Joslyn SA.
Publication Types: Comment; Letter
PMID: 7897783 [PubMed - indexed for MEDLINE]
