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.
Similar content being viewed by others
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
References
Chevarley F, White E (1997) Recent trends in breast cancer mortality among white and black US women. Am J Public Health 87:775–781
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 97:439–448
Dayal HH, Power RN, Chiu C (1982) Race and socio-economic status in survival from breast cancer. J Chronic Dis 35:675–683
Lyman GH, Kuderer NM, Lyman SL, Cox CE, Reintgen D, Baekey P (1997) Importance of race on breast cancer survival. Ann SurgOncol 4:80–87
Shavers VL, Harlan LC, Stevens JL (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97:134–147
Joslyn SA (2002) Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 95:1759–1766
Henson DE, Chu KC, Levine PH (2003) Histologic grade, stage, and survival in breast carcinoma: comparison of African American and Caucasian women. Cancer 98:908–917
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 101:1293–1301
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 56:1704–1709
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 82:1684–1692
Bernstein L, Ross RK (1993) Endogenous hormones and breast cancer risk. Epidemiol Rev 15:48–65
Polednak AP (2003) Trends in incidence rates for obesity-associated cancers in the US. Cancer Detect Prev 27:415–421
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 98:894–899
CDC. General Mortality USA. http://www.cdc.gov/nchs/data/statab/gm292a_4.pdf . 2006. Ref Type: Internet Communication
Axtell LM, Myers MH (1978) Contrasts in survival of black and white cancer patients, 1960–73. J Natl Cancer Inst. 60:1209–1215
Young JL Jr, Ries LG, Pollack ES (1984) Cancer patient survival among ethnic groups in the United States. J Natl Cancer Inst 73:341–352
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 88:1571–1579
Dignam JJ (2000) Differences in breast cancer prognosis among African American and Caucasian women. CA Cancer J Clin 50:50–64
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 101:3–27
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 95:1276–1299
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 94:1626–1634
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 84:938–950
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 85:1129–1137
Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94:490–496
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 95:1401–1414
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 81:21–31
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 3:127–135
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 86:705–712
Welch HG, Schwartz LM, Woloshin S (2000) Are increasing 5-year survival rates evidence of success against cancer? JAMA 283:2975–2978
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 294:1765–1772
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 278:1407–1411
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 13:325–332
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 146:394–404
Flegal KM, Graubard BI, Williamson DF, Gail MH (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293:1861–1867
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 14:1686–1691
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 14:2009–2014
Polednak AP (2004) Racial differences in mortality from obesity-related chronic diseases in US women diagnosed with breast cancer. Ethn Dis 14:463–468
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sarker, M., Jatoi, I. & Becher, H. Racial differences in breast cancer survival in women under age 60. Breast Cancer Res Treat 106, 135–141 (2007). https://doi.org/10.1007/s10549-006-9478-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-006-9478-3