J Natl Cancer Inst 1999 Sep 1;91(17):1487-91
Comment in:
J Natl Cancer Inst. 2000 Oct 18;92(20):1690-1.
Race and differences in breast cancer survival in a managed care population.
Yood MU, Johnson CC, Blount A, Abrams J, Wolman E, McCarthy BD, Raju U,
Nathanson DS, Worsham M, Wolman SR.
Josephine Ford Cancer Center and Center for Clinical Effectiveness, Henry
Ford Health Sciences Center, Detroit, MI, USA. ulcickam@bms.com
BACKGROUND: African-American women with breast cancer
have poorer survival than European-American women. After adjustment for
socioeconomic variables, survival differences diminish but do not disappear,
possibly because of residual differences in health care access, biology,
or behavior. This study compared breast cancer survival in African-American
and European-American women with similar health care access.
METHODS: We measured survival in women with breast cancer
who are served by a large medical group and a metropolitan Detroit health
maintenance organization where screening, diagnosis, treatment, and follow-up
are based on standard practices and mammography is a covered benefit.
We abstracted data on African-American and European-American women who
had been diagnosed with breast cancer from January 1986 through April
1996 (n = 886) and followed these women for survival through April 1997
(137 deaths).
RESULTS: African-American women were diagnosed at a later
stage than were European-American women. Median follow-up was 50 months.
Five-year survival was 77% for African-American and 84% for European-American
women. The crude hazard ratio for African-American women relative to European-American
women was 1.6 (95% confidence interval [CI] = 1.1-2.2). Adjusting only
for stage, the hazard ratio was 1.3 (95% CI = 0.9-1.9). Adjusting only
for sociodemographic factors (age, marital status, and income), the hazard
ratio was 1.2 (95% CI = 0.8-1.9). After adjusting for age, marital status,
income, and stage, the hazard ratio was 1.0 (95% CI = 0.7-1.5).
CONCLUSION: Among women with similar medical care access
since before their diagnoses, we found ethnic differences in stage of
breast cancer at diagnosis. Adjustment for this difference and for income,
age, and marital status resulted in a negligible effect of race on survival.
PMID: 10469750 [PubMed - indexed for MEDLINE]
J Natl Cancer Inst 2000 Oct 18;92(20):1690-1
Comment on:
J Natl Cancer Inst. 1999 Sep 1;91(17):1487-91.
Re: race and differences in breast cancer survival in a managed care population.
Dunmore C, Plummer P, Regan G, Mattingly D, Jackson S, Millikan R.
Publication Types: Comment; Letter
PMID: 11036116 [PubMed - indexed for MEDLINE]
