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Inflammatory and non-inflammatory breast cancer survival by socioeconomic position in the Surveillance, Epidemiology, and End Results database, 1990–2008

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Abstract

Although it has been previously reported that patients with inflammatory breast cancer (IBC) experience worse survival than patients with other breast cancer (BC) types, the socioeconomic and ethnic factors leading to this survival difference are not fully understood. The association between county-level percent of persons below the poverty level and BC-specific (BCS) survival for cases diagnosed from 1990 to 2008 in the Surveillance, Epidemiology, and End Results (SEER) database linked to census derived county attributes was examined. A sub-analysis of cases from 2000 to 2008 also examined BCS survival by an index combining percent below poverty and less than high school graduates as well as metropolitan versus non-metropolitan county of residence. The Kaplan–Meier estimator was used to construct survival curves by stage, inflammatory status, and county-level socioeconomic position (SEP). Stage and inflammatory status stratified proportional hazards models, adjusted for age, race/ethnicity, tumor and treatment characteristics were used to determine the hazard of BCS death by county-level SEP. Kaplan–Meier survival curves indicated IBC has worse survival than stage matched non-IBC, (stage III IBC median survival = 4.75 years vs. non-IBC = 13.4 years, p < 0.0001). Residing in a lower SEP, non-metro county significantly worsens BCS survival for non-IBC in multivariate proportional hazards models. African American cases appear to have worse survival than non-Hispanic Whites regardless of inflammatory status, stage, county-level SEP, tumor, or treatment characteristics. This is the first study to examine IBC survival by SEP in a nation-wide population-based tumor registry. As this analysis found generally poorer survival for IBC, regardless of SEP or race/ethnicity, it is important that interventions that help educate women on IBC symptoms target women in various SEP and race/ethnicity groups.

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Acknowledgments

The authors thank Dr. William Anderson at the Division of Cancer Epidemiology and Genetics, National Cancer Institute, for providing expertise on IBC and the SEER database, as well as the merged race-ethnicity and stage SEER*stat variables used in this analysis. This work was supported by a Rackham Merit Fellowship (JAS) from the University of Michigan and the Cancer Epidemiology Education in Special Populations Program of the University of Michigan (CA R25 112383). Additional funding was received from the Avon Foundation (AS and SDM), the Breast Cancer Research Foundation (SDM), and the Debbie Strange-Browne Inflammatory Breast Cancer Foundation (SDM).

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Authors and Affiliations

  1. Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory St., Ann Arbor, MI, 48109-2029, USA

    Jennifer A. Schlichting, Amr S. Soliman, David Schottenfeld & Sofia D. Merajver

  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA

    Catherine Schairer

  3. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA

    David Schottenfeld & Sofia D. Merajver

  4. Center for Global Health, University of Michigan, Ann Arbor, MI, 48104, USA

    Sofia D. Merajver

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  1. Jennifer A. Schlichting
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  3. Catherine Schairer
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  5. Sofia D. Merajver
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Correspondence to Jennifer A. Schlichting.

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Schlichting, J.A., Soliman, A.S., Schairer, C. et al. Inflammatory and non-inflammatory breast cancer survival by socioeconomic position in the Surveillance, Epidemiology, and End Results database, 1990–2008. Breast Cancer Res Treat 134, 1257–1268 (2012). https://doi.org/10.1007/s10549-012-2133-2

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