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Breast Cancer Research and Treatment

, Volume 106, Issue 1, pp 135–141 | Cite as

Racial differences in breast cancer survival in women under age 60

  • Malabika Sarker
  • Ismail Jatoi
  • Heiko Becher
Epidemiology

Abstract

Introduction

There is a known difference in breast cancer survival between races in the US for which several factors such as social, lifestyle and genetic factors may be relevant.

Method

This is a retrospective study among women entitled to free treatment in the US department of defense health care system. Within this group, we investigated the temporal trend of absolute survival of 13,793 of White and African American aged 20–59 years and diagnosed between 1980 and 1999 with breast cancer.

Result

There is a 3% overall improvement in survival in whites which can be explained by an earlier detection, and a two percent decrease in AA with a distinct pattern by age group. In the 40–49 year age group, the survival in white increases from 84.5% in the year 1980–1984 to 87.4 % in the year 1995–1999, in AA we estimate a decrease from 79.7% to 78.5%. When accounting for stage at diagnosis a slight reduction in survival in whites and a strong reduction in AA indicates a significant interaction between race and calendar period. The differences in survival patterns between blacks and whites are mainly caused by breast cancer and not by other causes.

Conclusion

The gap in survival which strongly increased with calendar period cannot be explained by unequal access to health care. Possible explanations include a lower participation of early detection programs for breast cancer in AA and an increasing prevalence of obesity over time which is more pronounced in AA than in whites.

Keywords

Absolute survival African American Breast cancer Obesity US 

Abbreviations

AA

African American

ER

Estrogen receptor

DoD

Department of Defense

ACTUR

Automated Central Tumor Registry

R

Race

AD

Age at diagnosis

YD

Year of diagnosis

S

Stage at diagnosis

BMI

Body Mass Index

Notes

Acknowledgements

We would like to specially thank Heribert Ramroth and Volker Arndt for help in programming. We would also like to thank Charles Leake for his valuable contributions in earlier stages within that project.

References

  1. 1.
    Chevarley F, White E (1997) Recent trends in breast cancer mortality among white and black US women. Am J Public Health 87:775–781PubMedCrossRefGoogle Scholar
  2. 2.
    Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, Dolan NC, Paskett ED, McTiernan A, Hubbell FA, Adams-Campbell LL, Prentice R (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97:439–448PubMedCrossRefGoogle Scholar
  3. 3.
    Dayal HH, Power RN, Chiu C (1982) Race and socio-economic status in survival from breast cancer. J Chronic Dis 35:675–683PubMedCrossRefGoogle Scholar
  4. 4.
    Lyman GH, Kuderer NM, Lyman SL, Cox CE, Reintgen D, Baekey P (1997) Importance of race on breast cancer survival. Ann SurgOncol 4:80–87Google Scholar
  5. 5.
    Shavers VL, Harlan LC, Stevens JL (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97:134–147PubMedCrossRefGoogle Scholar
  6. 6.
    Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95:1759–1766PubMedCrossRefGoogle Scholar
  7. 7.
    Henson DE, Chu KC, Levine PH (2003) Histologic grade, stage, and survival in breast carcinoma: comparison of African American and Caucasian women. Cancer 98:908–917PubMedCrossRefGoogle Scholar
  8. 8.
    Jones BA, Kasl SV, Howe CL, Lachman M, Dubrow R, Curnen MM, Soler-Vila H, Beeghly A, Duan F, Owens P (2004) African-American/White differences in breast carcinoma: p53 alterations and other tumor characteristics. Cancer 101:1293–1301PubMedCrossRefGoogle Scholar
  9. 9.
    Natarajan N, Nemoto T, Mettlin C, Murphy GP (1985) Race-related differences in breast cancer patients. Results of the 1982 national survey of breast cancer by the American College of Surgeons. Cancer 56:1704–1709PubMedCrossRefGoogle Scholar
  10. 10.
    Coates RJ, Clark WS, Eley JW, Greenberg RS, Huguley CM Jr, Brown RL (1990) Race, nutritional status, and survival from breast cancer. J Natl Cancer Inst 82:1684–1692PubMedCrossRefGoogle Scholar
  11. 11.
    Bernstein L, Ross RK (1993) Endogenous hormones and breast cancer risk. Epidemiol Rev 15:48–65PubMedGoogle Scholar
  12. 12.
    Polednak AP (2003) Trends in incidence rates for obesity-associated cancers in the US. Cancer Detect Prev 27:415–421PubMedCrossRefGoogle Scholar
  13. 13.
    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 98:894–899PubMedCrossRefGoogle Scholar
  14. 14.
    CDC. General Mortality USA. http://www.cdc.gov/nchs/data/statab/gm292a_4.pdf . 2006. Ref Type: Internet CommunicationGoogle Scholar
  15. 15.
    Axtell LM, Myers MH (1978) Contrasts in survival of black and white cancer patients, 1960–73. J Natl Cancer Inst. 60:1209–1215PubMedGoogle Scholar
  16. 16.
    Young JL Jr, Ries LG, Pollack ES (1984) Cancer patient survival among ethnic groups in the United States. J Natl Cancer Inst 73:341–352PubMedGoogle Scholar
  17. 17.
    Chu KC, Tarone RE, Kessler LG, Ries LA, Hankey BF, Miller BA, Edwards BK (1996) Recent trends in U.S. breast cancer incidence, survival, and mortality rates. J Natl Cancer Inst 88:1571–1579PubMedCrossRefGoogle Scholar
  18. 18.
    Dignam JJ (2000) Differences in breast cancer prognosis among African American and Caucasian women. CA Cancer J Clin 50:50–64PubMedGoogle Scholar
  19. 19.
    Jemal A, Clegg LX, Ward E, Ries LA, Wu X, Jamison PM, Wingo PA, Howe HL, Anderson RN, Edwards BK (2004) Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer 101:3–27PubMedCrossRefGoogle Scholar
  20. 20.
    Weir HK, Thun MJ, Hankey BF, Ries LA, Howe HL, Wingo PA, Jemal A, Ward E, Anderson RN, Edwards BK (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 95:1276–1299PubMedGoogle Scholar
  21. 21.
    Mariotto A, Feuer EJ, Harlan LC, Wun LM, Johnson KA, Abrams J (2002) Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 1975–1999. J Natl Cancer Inst 94:1626–1634PubMedGoogle Scholar
  22. 22.
    Coates RJ, Bransfield DD, Wesley M, Hankey B, Eley JW, Greenberg RS, Flanders D, Hunter CP, Edwards BK, Forman M (1992) Differences between black and white women with breast cancer in time from symptom recognition to medical consultation. Black/White Cancer Survival Study Group. J Natl Cancer Inst 84:938–950PubMedCrossRefGoogle Scholar
  23. 23.
    Hunter CP, Redmond CK, Chen VW, Austin DF, Greenberg RS, Correa P, Muss HB, Forman MR, Wesley MN, Blacklow RS (1993) Breast cancer: factors associated with stage at diagnosis in black and white women. Black/White Cancer Survival Study Group. J Natl Cancer Inst 85:1129–1137PubMedCrossRefGoogle Scholar
  24. 24.
    Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94:490–496PubMedGoogle Scholar
  25. 25.
    Mandelblatt JS, Kerner JF, Hadley J, Hwang YT, Eggert L, Johnson LE, Gold K (2002) Variations in breast carcinoma treatment in older medicare beneficiaries: is it black or white. Cancer 95:1401–1414PubMedCrossRefGoogle Scholar
  26. 26.
    Griggs JJ, Sorbero ME, Stark AT, Heininger SE, Dick AW (2003) Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Res Treat 81:21–31PubMedCrossRefGoogle Scholar
  27. 27.
    Chen VW, Correa P, Kurman RJ, Wu XC, Eley JW, Austin D, Muss H, Hunter CP, Redmond C, Sobhan M (1994) Histological characteristics of breast carcinoma in blacks and whites. Cancer Epidemiol Biomarkers Prev 3:127–135PubMedGoogle Scholar
  28. 28.
    Elledge RM, Clark GM, Chamness GC, Osborne CK (1994) Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst 86:705–712PubMedCrossRefGoogle Scholar
  29. 29.
    Welch HG, Schwartz LM, Woloshin S (2000) Are increasing 5-year survival rates evidence of success against cancer? JAMA 283:2975–2978PubMedCrossRefGoogle Scholar
  30. 30.
    Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D (2005) Comorbidity and survival disparities among black and white patients with breast cancer. JAMA 294:1765–1772PubMedCrossRefGoogle Scholar
  31. 31.
    Huang Z, Hankinson SE, Colditz GA, Stampfer MJ, Hunter DJ, Manson JE, Hennekens CH, Rosner B, Speizer FE, Willett WC (1997) Dual effects of weight and weight gain on breast cancer risk. JAMA 278:1407–1411PubMedCrossRefGoogle Scholar
  32. 32.
    Petrelli JM, Calle EE, Rodriguez C, Thun MJ (2002) Body mass index, height, and postmenopausal breast cancer mortality in a prospective cohort of US women. Cancer Causes Control 13:325–332PubMedCrossRefGoogle Scholar
  33. 33.
    Jones BA, Kasi SV, Curnen MG, Owens PH, Dubrow R (1997) Severe obesity as an explanatory factor for the black/white difference in stage at diagnosis of breast cancer. Am J Epidemiol 146:394–404PubMedGoogle Scholar
  34. 34.
    Flegal KM, Graubard BI, Williamson DF, Gail MH (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293:1861–1867PubMedCrossRefGoogle Scholar
  35. 35.
    Loi S, Milne RL, Friedlander ML, McCredie MR, Giles GG, Hopper JL, Phillips KA (2005) Obesity and outcomes in premenopausal and postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14:1686–1691PubMedCrossRefGoogle Scholar
  36. 36.
    Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2005) Body mass and mortality after breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 14:2009–2014PubMedCrossRefGoogle Scholar
  37. 37.
    Polednak AP (2004) Racial differences in mortality from obesity-related chronic diseases in US women diagnosed with breast cancer. Ethn Dis 14:463–468PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Tropical Hygiene and Public HealthUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Surgery, National Naval Medical CenterUniformed Services UniversityBethesdaUSA

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