Annals of Surgical Oncology

, Volume 4, Issue 1, pp 80–87 | Cite as

Importance of race on breast cancer survival

  • Gary H. Lyman
  • Nicole M. Kuderer
  • Stephen L. Lyman
  • Charles E. Cox
  • Douglas Reintgen
  • Paul Baekey
Original Articles

Abstract

Background: Breast cancer survival has been shown to be significantly less among black women than white women. The reason for this difference in survival is unclear.

Methods: Data were obtained retrospectively on 439 women seen between 1985 and 1993 based on a detailed chart audit. The impact of race and several known prognostic factors on overall survival, time to relapse, and survival after relapse were studied.

Results: Black women with breast cancer were found to have a greater risk of recurrence, shorter overall survival, and shorter survival after relapse than did white women. Black patients were found to be younger and have higher stage of disease and lower hormone receptor levels than were white patients. After adjustment for menopausal status and disease stage, a significant independent effect of race was observed on overall survival but not risk of recurrence. In multivariate analysis, a significant interaction was observed between race and age in some models. Survival after recurrence of disease was lower among black than white women after adjustment for menopausal status and estrogen receptor level.

Conclusion: Black women experience shorter survival times than do white women, including a shorter survival time after disease recurrence. Breast cancer in black women is associated with younger age, higher stage at presentation, and low hormone receptor levels. After adjustment for known prognostic factors, race remains a significant independent predictor of breast cancer survival.

Key Words

Breast cancer Race Blacks Prognostic factors Survival 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Wingo PA, Tong T, Bolden S. Cancer statistics, 1995.CA 1995;45:8–30.PubMedGoogle Scholar
  2. 2.
    Miller BA, Ries LAG, Hankey BF, et al., eds.SEER cancer statistics Review: 1973–1990. Bethesda, MD: National Cancer Institute.Google Scholar
  3. 3.
    Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer: results of the National Cancer Institute black/white cancer survival study.JAMA 1994;292:947–54.Google Scholar
  4. 4.
    Hunter CP, Redmond C, Chen VW, et al. Breast cancer: factors associated with stage at diagnosis in black and white women.J Natl Cancer Inst 1993;85:1129–37.PubMedGoogle Scholar
  5. 5.
    Swanson GM, Lin C-S. Survival patterns among younger women with breast cancer: the effects of age, race, stage and treatment.J Natl Cancer Inst 1994;16:69–77.Google Scholar
  6. 6.
    Chen F, Trapido EJ, Davis K. Differences in stage at presentation of breast and gynecologic cancers among whites, blacks and Hispanics.Cancer 1994;73:2838–42.PubMedGoogle Scholar
  7. 7.
    Damsey RD, Hessel PA, Browde S, et al. Lack of a significant independent effect of race on survival in breast cancer.Cancer 1988;61:1908–12.Google Scholar
  8. 8.
    Elledge RM, Clark GM, Chamness GC, Osborne CK. Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States.J Natl Cancer Inst 1994;86:705–12.PubMedGoogle Scholar
  9. 9.
    Chen VW, Correa P, Kurman RJ, et al. Histological characteristics of breast carcinoma in blacks and whites.Cancer Epidemiol Biomarkers Prevent 1994;3:127–35.Google Scholar
  10. 10.
    Reynolds P, Boyd PT, Blacklow RS, et al. The relationship between social ties and survival among black and white breast cancer patients.Cancer Epidemiol Biomarkers Prevent 1994;3:253–9.Google Scholar
  11. 11.
    Gordon NH, Crowe JP, Brumberg DJ, Berger NA. Socioeconomic factors and race in breast cancer recurrence and survival.Am J Epidemiol 1992;135:609–18.PubMedGoogle Scholar
  12. 12.
    Gart JJ, Thomas DG. The performance of three approximate confidence limit methods for the odds ratio.Am J Epidemiol 1982;115:453–70.PubMedGoogle Scholar
  13. 13.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–81.Google Scholar
  14. 14.
    Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration.Cancer Chemother Rep 1966;50:163–70.PubMedGoogle Scholar
  15. 15.
    Peto R, Pike MC, Armitage P, et al. Design and analysis of randomized trials requiring prolonged observation of each patient. II. Analysis and examples.Br J Cancer 1977;35:1–39.PubMedGoogle Scholar
  16. 16.
    Cox D. Regression models and lifetables.R J Stat Soc 1972;34:187.Google Scholar
  17. 17.
    Bartolucci AA, Fraser FD. Comparative step-upward composite tests for selecting prognostic indicators associated with survival.Biomet J 1977;19:437–48.Google Scholar
  18. 18.
    Elias EG, Suter CM, Brown SD, Buda BS, Vachon DA. Survival differences between black and white women with breast cancer.J Surg Oncol 1994;55:37–41.PubMedGoogle Scholar
  19. 19.
    Gregorio DI, Cummings M, Michalek A. Delay, stage of disease, and survival among white and black women with breast cancer.Am J Public Health 1983;73:590–3.PubMedGoogle Scholar
  20. 20.
    Moormeier J. Breast cancer in black women.Ann Intern Med 1996;124:897–905.PubMedGoogle Scholar
  21. 21.
    Jones BA, Kasl SV, Curnen MGM, Owens PH, Dubrow R. Can mammography screening explain the race difference in stage at diagnosis of breast cancer.Cancer 1995;75:2103–13.PubMedGoogle Scholar
  22. 22.
    Caplan LS, Helzlsouer KJ, Shapiro S, Freedman LS, Coates RJ, Edwards BK. System delay in breast cancer in whites and blacks.Am J Epidemiol 1995;142:804–12.PubMedGoogle Scholar
  23. 23.
    Cella DF, Orav EJ, Kornblith AB, et al. Socioeconomic status and cancer survival.J Clin Oncol 1991;9:1500–9.PubMedGoogle Scholar
  24. 24.
    Ansell D, Whitman S, Lipton R, Cooper R. Race, income, and survival from breast cancer at two public hospitals.Cancer 1993;72:2974–8.PubMedGoogle Scholar
  25. 25.
    Richardson JL, Lanholz B, Bernstein L, Burciaga C, Danley K, Ross RK. Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year.Br J Cancer 1992;65:922–6.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 1997

Authors and Affiliations

  • Gary H. Lyman
    • 1
    • 4
  • Nicole M. Kuderer
    • 1
  • Stephen L. Lyman
    • 1
    • 4
  • Charles E. Cox
    • 2
  • Douglas Reintgen
    • 2
  • Paul Baekey
    • 3
  1. 1.From the Department of Internal Medicine, the H. Lee Moffitt Cancer Center and Research InstituteUniversity of South FloridaTampaUSA
  2. 2.Department of Surgery, the H. Lee Moffitt Cancer Center and Research InstituteUniversity of South FloridaTampaUSA
  3. 3.Department of Pathology, the H. Lee Moffitt Cancer Center and Research InstituteUniversity of South FloridaTampaUSA
  4. 4.Department of Epidemiology and Biostatistics, the H. Lee Moffitt Cancer Center and Research InstituteUniversity of South FloridaTampaUSA

Personalised recommendations