Abstract
Background
Despite advances in treatment and increased screening, female breast cancer survival is affected by race, ethnicity, and socioeconomic status (SES). The purpose of this study was to substantiate disparities in breast cancer mortality in a large and unique dataset containing 7 distinct racial groups, 31 comorbidities, demographic and clinical/pathological patient characteristics, and neighborhood poverty information.
Methods
Florida Cancer Data System registry (1996–2007) linked with the Agency for Health Care Administration and U.S. Census tract (n = 127,754) explored median survival and 1-, 3-, and 5-year survival rates by the Kaplan–Meier method. Log-rank tests compared survival curves by race/ethnicity/SES. Cox proportional hazards regression models were used to obtain unadjusted and adjusted hazard ratios (HR) and 95 % confidence intervals.
Results
Native Americans had the lowest median survival (7.4 years) and Asians had the highest (12.6 years). For the univariate analysis, worse survival was seen for blacks (HR = 1.44; p < 0.001) and better survival for Asians (HR = 0.71; p < 0.001), Asian Indians or Pakistanis (HR = 0.65; p = 0.013), and Hispanics (HR = 0.92; p < 0.001). Multivariate analysis demonstrated sustained survival detriment for blacks (HR = 1.28; p < 0.001) and improved survival for Hispanics (HR = 0.90; p = 0.001). For SES, there was an incremental improvement in survival for each higher SES category in all analyses (p < 0.001).
Conclusions
Utilizing a large enriched state cancer registry controlling for multiple demographic, clinical, and comorbidities, we fully explored survival disparities in female breast cancer and found certain aspects of race, ethnicity, and SES to remain significantly associated with breast cancer survival. More research is needed to uncover the source of these ongoing disparities.
Similar content being viewed by others
References
CDC Centers for Disease Control and Prevention (2012) Cancer among women, 2012. http://www.cdc.gov/cancer/dcpc/data/women.htm. Accessed November 2012
CDC Centers for Disease Control and Prevention (2012) Breast Cancer Statistics, 2012. http://www.cdc.gov/cancer/breast/statistics/. Accessed November 2012
Siegel R, DeSantis C, Virgo K et al (2012) Cancer treatment and survivorship statistics. CA Cancer J Clin 62(4):220–241
National Cancer Institute (2012) SEER Stat Fact Sheets: Breast, 2012. http://seer.cancer.gov/statfacts/html/breast.html. Accessed November 2012
Maskarinec G, Sen C, Koga K, Conroy SM (2011) Ethnic differences in breast cancer survival: status and determinants. Women’s Health 7(6):677–687
Florida Cancer Data System (2012) Florida’s statewide population-based cancer registry, 2012. http://fcds.med.miami.edu/welcome.html. Accessed November 2012
Agency for Healthcare Administration (2012) http://ahca.myflorida.com/index.shtml. Accessed November 2012
Chlebowski RT, Chen Z, Anderson GL et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97(6):439–448
Grann V, Troxel AB, Zojwalla N, Hershman D, Glied SA, Jacobson JS (2006) Regional and racial disparities in breast cancer-specific mortality. Soc Sci Med 62(2):337–347
Joslyn SA, West MM (2000) Racial differences in breast carcinoma survival. Cancer 88(1):114–123
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):1303–1311
Clegg LX, Reichman ME, Miller BA et al (2009) Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: national longitudinal mortality study. Cancer Causes Control 20(4):417–435
Miller BA, Chu KC, Hankey BF, Ries LA (2008) Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S. Cancer Causes Control 19(3):227–256
Braun KL, Fong M, Gotay C, Pagano IS, Chong C (2005) Ethnicity and breast cancer in Hawaii: increased survival but continued disparity. Ethn Dis 15(3):453–460
Leung GM, Thach TQ, Chan E et al (2005) Short-term, medium-term, long-term, and lifetime risks of developing and dying of breast carcinoma in a Westernized Chinese population: evidence from Hong Kong between 1976 and 2000. Cancer 103(3):501–508
Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163(1):49–56
Gomez SL, Clarke CA, Shema SJ, Chang ET, Keegan TH, Glaser SL (2010) Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. Am J Public Health 100(5):861–869
Redaniel MT, Laudico A, Mirasol-Lumague MR et al (2010) Breast cancer survival in different country settings: comparisons between a Filipino resident population, Filipino-Americans and Caucasians. Breast 19(2):109–114
Moran MS, Gonsalves L, Goss DM, Ma S (2011) Breast cancers in U.S. residing Indian-Pakistani versus non-Hispanic White women: comparative analysis of clinical-pathologic features, treatment, and survival. Breast Cancer Res Treat 128(2):543–551
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):1985–1993
Dasgupta P, Baade PD, Aitken JF, Turrell G (2012) Multilevel determinants of breast cancer survival: association with geographic remoteness and area-level socioeconomic disadvantage. Breast Cancer Res Treat 132(2):701–710
Du XL, Fang S, Meyer TE (2008) Impact of treatment and socioeconomic status on racial disparities in survival among older women with breast cancer. Am J Clin Oncol 31(2):125–132
Puliti D, Miccinesi G, Manneschi G et al (2012) Does an organised screening programme reduce the inequalities in breast cancer survival? Ann Oncol 23(2):319–323
Cross CK, Harris J, Recht A (2002) Race, socioeconomic status, and breast carcinoma in the U.S: what have we learned from clinical studies. Cancer 95(9):1988–1999
Newman LA, Mason J, Cote 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):2844–2854
Gerend MA, Pai M (2008) Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 17(11):2913–2923
Vona-Davis L, Rose DP (2009) The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: a review. J Womens Health 18(6):883–893
Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82(5):703–710
Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163:49–56
Deshpande AD, Jeffe DB, Gnerlich J, Iqbal AZ, Thummalakunta A, Margenthaler JA (2009) Racial disparities in breast cancer survival: an analysis by age and stage. J Surg Res 153:105–113
Acknowledgments
This work was supported by the James & Esther King Florida Biomedical Research Program (Grant number 10 KG-06).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tannenbaum, S.L., Koru-Sengul, T., Miao, F. et al. Disparities in survival after female breast cancer diagnosis: a population-based study. Cancer Causes Control 24, 1705–1715 (2013). https://doi.org/10.1007/s10552-013-0246-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-013-0246-5