Breast Cancer Research and Treatment

, Volume 97, Issue 2, pp 149–155

Racial differences in breast cancer survival in the Detroit Metropolitan area

  • Michael S. Simon
  • Mousumi Banerjee
  • Heather Crossley-May
  • Fawn D. Vigneau
  • Anne-Michelle Noone
  • Kendra Schwartz


African American (AA) women have poorer breast cancer survival compared to Caucasian American (CA) women. The purpose of this analysis was to determine whether socioeconomic status (SES) and treatment differences influence racial differences in breast cancer survival. The study population included 9,321 women (82% CA, 18% AA) diagnosed with local (63%) or regional (37%) stage disease between 1988 and 1992, identified through the Metropolitan Detroit SEER registry. Data on SES were obtained through linkage with the 1990 Census of Population and Housing Summary Tape and cases were geocoded to census block groups. Pathology, treatment and survival data were obtained through SEER. Cox proportional hazards models were used to compare survival for AA versus CA women after adjusting for age, SES, tumor size, number of involved lymph nodes, and treatment. AA␣women were more likely to live in a geographic area classified as working poor than were CA women (p<0.001). AA women were less likely to have lumpectomy and radiation and more likely to have mastectomy with radiation (p<0.001). After multivariable adjusted analysis, there were no significant racial differences in survival among women with local stage disease, although AA women with regional stage disease had persistent but attenuated poorer survival compared to CA women. After adjusting for known clinical and SES predictors of survival, AA and CA women who are diagnosed with local disease demonstrate similar overall and breast cancer-specific survival, while race continues to have an independent effect among women presenting at a later stage of disease.


breast cancer racial differences survival 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Simon MS, Korczak JF, Yee CL, Daling JR, Malone KE, Bernstein L, et al. 2005 Racial differences in the familial aggregation of breast cancer and other female cancers Breast Cancer Res Treat 89: 227–235PubMedCrossRefGoogle Scholar
  2. 2.
    Weir HK, Thun MJ, Hankey BF, Ries LA, Howe HL, Wingo PA, et al. 2003 Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control J Natl Cancer Inst 95(17):1276–1299PubMedGoogle Scholar
  3. 3.
    Simon MS, Severson RK, 1996 Racial differences in survival of female breast cancer in the Detroit metropolitan area Cancer 77(2):308–314PubMedCrossRefGoogle Scholar
  4. 4.
    Edwards MJ, Gamel JW, Vaughan WP, Wrightson WR, 1998 Infiltrating ductal carcinoma of the breast: the survival impact of race J Clin Oncol 16(8):2693–2699PubMedGoogle Scholar
  5. 5.
    O’Malley CD, Le GM, Glaser SL, Shema SJ, West DW, 2003 Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study Cancer 97(5):1303–1311PubMedCrossRefGoogle Scholar
  6. 6.
    Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK, 2002 Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study Arch Intern Med 162(17):1985–1993PubMedCrossRefGoogle Scholar
  7. 7.
    Shavers VL, Harlan LC, Stevens JL, 2003 Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35 Cancer 97(1):134–147PubMedCrossRefGoogle Scholar
  8. 8.
    Joslyn SA, 2002 Racial differences in treatment and survival from early-stage breast carcinoma Cancer 95(8):1759–1766PubMedCrossRefGoogle Scholar
  9. 9.
    Chu KC, Lamar CA, Freeman HP, 2003 Racial disparities in breast carcinoma survival rates: seperating factors that affect diagnosis from factors that affect treatment Cancer 97(11):2853–2860PubMedCrossRefGoogle Scholar
  10. 10.
    Joslyn SA, 2002 Hormone receptors in breast cancer: racial differences in distribution and survival Breast Cancer Res Treat 73(1):45–59PubMedCrossRefGoogle Scholar
  11. 11.
    Li CI, Malone KE, Daling JR, 2003 Differences in breast cancer stage, treatment, and survival by race and ethnicity Arch Intern Med 163(1):49–56PubMedCrossRefGoogle Scholar
  12. 12.
    Grann V, Troxel AB, Zojwalla N, Hershman D, Glied SA, Jacobson JS, 2005 Regional and racial disparities in breast cancer-specific mortality Soc Sci MedGoogle Scholar
  13. 13.
    Delgado DJ, Lin WY, Coffey M, 1995 The role of Hispanic race/ethnicity and poverty in breast cancer survival P R Health Sci J 14(2):103–116PubMedGoogle Scholar
  14. 14.
    Du W, Simon MS: Racial disparities in treatment and survival of women with stage I-III breast cancer at a large academic medical center in Metropolitan Detroit. Breast Cancer Res Treat, 2005Google Scholar
  15. 15.
    Wojcik BE, Spinks MK, Stein CR, 2003 Effects of screening mammography on the comparative survival rates of African American, white, and Hispanic beneficiaries of a comprehensive health care system Breast J 9(3):175–183PubMedCrossRefGoogle Scholar
  16. 16.
    Jatoi I, Becher H, Leake CR, 2003 Widening disparity in survival between white and African-American patients with breast carcinoma treated in the US Department of Defense Healthcare system Cancer 98(5):894–899PubMedCrossRefGoogle Scholar
  17. 17.
    Mancino AT, Rubio IT, Henry-Tillman R, Smith LF, Landes R, Spencer HJ, et al. 2001 Racial differences in breast cancer survival: the effect of residual disease J Surg Res 100(2):161–165PubMedCrossRefGoogle Scholar
  18. 18.
    Yood MU, Johnson CC, Blount A, Abrams J, Wolman E, McCarthy BD, et al. 1999 Race and differences in breast cancer survival in a managed care population J Natl Cancer Inst 91(17):1487–1491PubMedCrossRefGoogle Scholar
  19. 19.
    Ansell D, Whitman S, Lipton R, Cooper R, 1993 Race, income, and survival from breast cancer at two public hospitals Cancer 72(10):2974–2978PubMedCrossRefGoogle Scholar
  20. 20.
    Bradley CJ, Given CW, Roberts C, 2002 Race socioeconomic status, and breast cancer treatment and survival J Natl Cancer Inst 94(7):490–496PubMedGoogle Scholar
  21. 21.
    Gordon NH, Crowe JP, Brumberg DJ, Berger NA, 1992 Socioeconomic factors and race in breast cancer recurrence and survival Am J Epidemiol 135(6):609–618PubMedGoogle Scholar
  22. 22.
    Simon MS, Severson RK, 1997 Racial differences in breast cancer survival: the interaction of socioeconomic status and tumor biologyAm J Obstet Gynecol 176(6):S233–S239PubMedCrossRefGoogle Scholar
  23. 23.
    Diez-Roux AV, Kiefe CI, Jacobs DR, Jr., Haan M, Jackson SA, Nieto FJ, et al. 2001 Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies Ann Epidemiol 11(6):395–405PubMedCrossRefGoogle Scholar
  24. 24.
    International classification of diseases for oncology. 2nd ed. World Health Organization, Geneva, 1990Google Scholar
  25. 25.
    Henson DE, Ries L, Shambaugh EM, 1992 Survival results depend on the staging system Semin Surg Oncol 8(2):57–61PubMedCrossRefGoogle Scholar
  26. 26.
    Schwartz KL, Crossley-May H, Vigneau FD, Brown K, Banerjee M, 2003 Race, socioeconomic status and stage at diagnosis for five common malignancies Cancer Causes Control 14(8):761–766PubMedCrossRefGoogle Scholar
  27. 27.
    US Census Bureau. Census of Population and Housing (1990) Summary Tape File 3 Technical Documentation. 1991. US Census Bureau Washington DCGoogle Scholar
  28. 28.
    Krieger N, Quesenberry C Jr., Peng T, Horn-Ross P, Stewart S, Brown S, et al. 1999 Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988–92 (United States) Cancer Causes Control 10(6):525–537PubMedCrossRefGoogle Scholar
  29. 29.
    Neter J, Wasserman W, Kutner M, 1985 Applied linear statistical models: regression, analysis of variance and experimental design. 2nd ed Richard D. Irwin, Inc., Homewood, ILGoogle Scholar
  30. 30.
    Cox DR, Oakes DO, 1984 Analysis of survival data. Chapman and Hall, LondonGoogle Scholar
  31. 31.
    Newman LA, Mason J, Cote D, Vin Y, Carolin K, Bouwman D, et al. 2002 African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast Cancer 94(11):2844–2854PubMedCrossRefGoogle Scholar
  32. 32.
    Shavers VL, Brown ML, 2002 Racial and ethnic disparities in the receipt of cancer treatment J Natl Cancer Inst 94(5):334–357PubMedGoogle Scholar
  33. 33.
    Chuba PJ, Simon MS, 1997 Trends in primary surgical and radiation therapy for localized breast cancer in the Detroit Metropolitan area 1973–1992 Int J Radiat Oncol Biol Phys 38(1):103–107PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Michael S. Simon
    • 1
    • 2
    • 5
  • Mousumi Banerjee
    • 3
  • Heather Crossley-May
    • 2
  • Fawn D. Vigneau
    • 2
  • Anne-Michelle Noone
    • 3
  • Kendra Schwartz
    • 2
    • 4
  1. 1.Division of Hematology and OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitUSA
  2. 2.Population Studies and Prevention ProgramKarmanos Cancer Institute at Wayne State UniversityDetroitUSA
  3. 3.Department of Biostatistics, School of Public HealthUniversity of MichiganAnn ArborUSA
  4. 4.Department of Family MedicineWayne State UniversityDetroitUSA
  5. 5.Barbara Ann Karmanos Cancer InstituteDetroitUSA

Personalised recommendations