Surveillance mammography use after treatment of primary breast cancer and racial disparities in survival
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- Nurgalieva, Z.Z., Franzini, L., Morgan, R. et al. Med Oncol (2013) 30: 691. doi:10.1007/s12032-013-0691-8
Racial and ethnic minority patients continue to die disproportionately from breast cancer compared with their white counterparts, even after adjusting for insurance status and income. No studies have examined whether surveillance mammography reduces racial disparities in survival among elderly breast cancer survivors following active treatment for breast cancer. This study included 28,117 cases diagnosed with primary breast cancer at age 66 years and over, identified from SEER data during 1992–2005. Kaplan–Meier methods and Cox regression models were used for survival analysis. A higher proportion of whites received surveillance mammograms during the surveillance period compared with nonwhites: 71.7 % of African-Americans, 72.5 % of Hispanics, and 69.3 % of Asians had mammograms compared with 74.9 % of whites. In propensity-score-adjusted analysis, women who had a mammogram within 2 years were less likely (hazard ratio 0.84; 95 % CI 0.78–0.82) to die from any cause compared with women who did not have any mammograms during this time period. The hazard ratio of cancer-specific mortality elevated for Hispanics compared with whites (hazard ratio 1.5; 95 % CI 0.6–3.2) and was reduced after adjusting for surveillance mammography (hazard ratio 1.4; 95 % CI 0.5–2.9). Similar pattern in the reduction in disease-specific hazard ratio was observed for blacks: After controlling for patient and tumor characteristics, hazard ratio was elevated but not significantly different from that in whites (hazard ratio 2.0; 95 % CI 0.9–3.7), and hazard ratio adjusting for surveillance mammography further reduced the point estimate (hazard ratio 1.5; 95 % CI 0.7–2.8). Asian and Pacific Islanders and Hispanics appeared to have lower risks of all-cause mortality compared with whites after controlling for patient and tumor characteristics and surveillance mammogram received. Our findings indicates that while surveillance mammograms and physician visits may play a contributory role in achieving equal outcomes for breast cancer-specific mortality for women with breast cancer, searching for other factors that might help achieve national goals to eliminate racial disparities in healthcare, and outcomes is warranted.