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Racial disparity in breast cancer survival: the impact of pre-treatment hematologic variables

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Abstract

Purpose

A survival disparity of black versus white breast cancer patients has been extensively documented but not adequately explained. Blacks and whites also have significant differences in hematologic traits including hemoglobin (HGB). However, a link between survival disparity and hematologic differences has not been reported. We aimed to explore the effect of pre-treatment hematologic variables on this survival disparity.

Methods

We sequentially matched 443 black patients, using a minimum distance approach, to four different sets of 443 whites on demographics (age, year of diagnosis, smoking, and drinking status), tumor presentation (all demographic variables plus tumor stage, grade, and hormone receptor status), treatment (all presentation variables plus surgery, chemotherapy, radiation therapy, and hormone therapy), and presentation plus pre-treatment hematologic variables. Racial survival for each matched dataset was analyzed by Cox proportional hazards model.

Results

We found that white patients matched on demographic characteristics had more favorable survival than blacks [hazard ratio (HR) 0.57, 95 % confidence interval (CI) 0.42–0.77, p log-rank = 0.0002]. Presentation match diminished this disparity [HR 0.72 (0.54–0.95), p log-rank = 0.0199], which was not further reduced in treatment match [HR 0.73 (0.55–0.96), p log-rank = 0.0249]. However, the survival disparity was largely reduced when pre-treatment level of HGB or red blood cell distribution width was further matched in addition to presentation match [HR 0.83 (0.64–1.09), p log-rank = 0.1819 and HR 0.83 (0.64–1.09), p log-rank = 0.1760, respectively].

Conclusions

We found that in our patient population, differences in tumor presentation and certain pre-treatment hematologic traits, but not treatment, were associated with the survival disparity between black and white breast cancer patients.

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Abbreviations

HGB:

Hemoglobin

HR:

Hazard ratio

CI:

Confidence interval

RDW:

Red blood cell distribution width

SEER:

Surveillance, epidemiology, and end results

SES:

Socioeconomic status

HCT:

Hematocrit

MCH:

Mean corpuscular hemoglobin

MCHC:

MCH concentration

MCV:

Mean corpuscular volume

RBC:

Red blood cell

WBC:

White blood cell

CBC:

Complete blood count

ER:

Estrogen receptor

PR:

Progesterone receptor

AJCC:

American Joint Committee on Cancer

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Acknowledgments

The work was supported by a start-up fund from Thomas Jefferson University, and a Research Scholar Grant from the V Foundation for Cancer Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Chun Wang, Yinzhi Lai, Ronald E. Myers, Zhong Ye, Kejin Zhang & Hushan Yang

  2. Department of Environmental Health, School of Public Health, Nantong University, Nantong, 226000, Jiangsu, China

    Chun Wang

  3. Department of Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Jesse Civan

  4. Division of Solid Tumor Oncology, Department of Medical Oncology, Breast Care Center, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Massimo Cristofanilli

  5. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA

    Terry Hyslop

  6. Department of Pathology, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Juan P. Palazzo

  7. Department of Molecular Physiology and Biophysics, Center for Human Genetics Research, Vanderbilt University, Nashville, TN, 37232, USA

    Bingshan Li

  8. Experimental Teaching Center, School of Basic Medicine, Fourth Military Medical University, Xi’an, 710032, Shanxi, China

    Jinliang Xing

Authors
  1. Chun Wang
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  2. Jesse Civan
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  3. Yinzhi Lai
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Correspondence to Hushan Yang.

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Wang, C., Civan, J., Lai, Y. et al. Racial disparity in breast cancer survival: the impact of pre-treatment hematologic variables. Cancer Causes Control 26, 45–56 (2015). https://doi.org/10.1007/s10552-014-0481-4

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  • DOI: https://doi.org/10.1007/s10552-014-0481-4

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