Abstract
Objective
To investigate differences in breast cancer prognostic factors between ethnic and socioeconomic groups in New Zealand.
Methods
We analyzed all 21,586 breast cancer cases on the New Zealand Cancer Registry (July 1994–June 2004). Māori, Pacific, and non-Māori/non-Pacific women were categorized according to ethnicity on the Registry. Deprivation was analyzed as quintiles of the New Zealand Deprivation Index 2001, an area-based measure of socioeconomic position. Logistic regression was used to estimate age-adjusted odds ratios (OR) (95% confidence intervals (CI)).
Results
Māori and Pacific women were more likely to have non-local stage, less well differentiated cancer, larger tumors and positive human epidermal growth factor receptor-type 2 (HER-2) status than non-Māori/non-Pacific women. Māori were less likely and Pacific women more likely than non-Māori/non-Pacific women to have negative oestrogen (ER) and progesterone receptor (PR) status. Adjusting for deprivation did not materially alter the results.
Women living in more deprived areas had a higher risk of non-local stage and larger tumors. These associations were only partially explained by ethnicity. There was no relationship between tumor grade, ER, PR or HER-2 status and deprivation.
Conclusions
Our results confirm that Māori, Pacific and low socioeconomic women present with poor prognosis breast tumors.
Similar content being viewed by others
References
Ferlay J, Parkin D, Pisani P (2001) Globocan 2000: cancer incidence, mortality and prevalence worldwide. IARC, Lyon
New Zealand Health Information Service (2006) Cancer: new registrations and deaths 2002. Ministry of Health, Wellington
Ajwani S, Blakely T, Robson B, Tobias M, Bonne M (2003) Decades of disparity: ethnic mortality trends in New Zealand 1980–1999. Ministry of Health & University of Otago, Wellington
Blakely T, Fawcett J, Atkinson J, Tobias M, Cheung K (2005) Decades of disparity II: socioeconomic mortality trends in New Zealand 1981–1999. Ministry of Health, Wellington
Robson B, Purdie G, Cormack D (2006) Unequal impact: Maori and non-Maori cancer statistics 1996–2001. Ministry of Health, Wellington
Foliaki S, Jeffreys M, Wright C, Blakey K, Pearce N (2004) Cancer in Pacific people in New Zealand: a descriptive study. Pacific Health Dialog 11:94–100
Wagener D, Schatzkin A (1994) Temporal trends in the socioeconomic gradient for breast cancer mortality among US women. Am J Public Health 84:1003–1006
Jeffreys M, Sarfati D, Stevanovic V et al (2005) Socioeconomic inequalities in cancer survival in New Zealand. Australas Epidemiol 12:60
Page A, Taylor R (2006) BreastScreen Aotearoa independent monitoring report July to December 2005. School of Population Health, University of Queensland
Sarfati D, Blakely T, Shaw C, Cormack D, Atkinson J (2006) Patterns of disparity: ethnic and socio-economic trends in breast cancer mortality in New Zealand. Cancer Causes Control 17:671–8
Lagerlund M, Bellocco R, Karlsson P, Tejler G, Lambe M (2005) Socio-economic factors and breast cancer survival—a population-based cohort study (Sweden). Cancer Causes Control 16:419–430
Ward E, Jemal A, Cokkinides V et al (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:78–93
Neal RD, Allgar VL (2005) Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the ‘National Survey of NHS Patients: Cancer’. Br J Cancer 92:1971–1975
Thomson CS, Hole DJ, Twelves CJ, Brewster DH, Black RJ (2001) Prognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival. J Epidemiol Community Health 55:308–315
Smedley B, Stith A, Nelson A (eds) (2002) Unequal treatment: confronting racial and ethnic disparities in health care. National Academic Press, Washington
Natarajan N, Nemoto T, Mettlin C, Murphy G (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
Dignam JJ (2000) Differences in breast cancer prognosis among African-American and Caucasian women. CA Cancer J Clin 50:50–64
Miller BA, Hankey BF, Thomas TL (2002) Impact of sociodemographic factors, hormone receptor status, and tumor grade on ethnic differences in tumor stage and size for breast cancer in US women. Am J Epidemiol 155:534–545
Boyd C, Zhang-Salomons JY, Groome PA, Mackillop WJ (1999) Associations between community income and cancer survival in Ontario, Canada and the United States. J Clin Oncol 17:2244–2255
Blakely T, Woodward A, Pearce N, Salmond C, Kiro C, Davis P (2002) Socio-economic factors and mortality among 25–64 year olds followed from 1991 to 1994: the New Zealand Census-Mortality Study. N Z Med J 115:93–97
Perkins P, Cooksley CD, Cox JD (1996) Breast cancer. Is ethnicity an independent prognostic factor for survival? Cancer 78:1241–1247
Bassett MT, Krieger N (1986) Social class and black–white differences in breast cancer survival. Am J Public Health 76:1400–1403
Gordon NH, Crowe JP, Brumberg J, Berger NA (1992) Socioeconomic factors and race in breast cancer recurrence and survival. Am J Epidemiol 135:609–618
Gold R, Michael Y, Whitlock E (2006) Race/ethnicity, socioeconomic status, and lifetime morbidity burden in the women’s health initiative: a cross-sectional analysis. J Women’s Health 15:1161–1173
Jeffreys M, Stevanovic V, Tobias M et al (2005) Ethnic inequalities in cancer survival in New Zealand: linkage study. Am J Public Health 95:834–837
Elledge R, Clark G, Chamnes G, Osborne C (1994) Tumour biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst 86:705–712
Furberg H, Millikan R, Dressler L, Newman B, Geradts J (2001) Tumor characteristics in African American and white women. Breast Cancer Res Treat 68:33–43
Krieger N, van den Eeden S, Zava D, Okamoto A (1997) Race/ethnicity, social class, and prevalence of breast cancer prognostic biomarkers: a study of white, black and Asian women in the San Francisco bay area. Ethn Dis 7:137–149
Li C, Malone K, Daling J (2002) Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomarkers Prev 11:601–607
Chlebowski RT, Chen Z, Anderson GL et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97:439–448
Shavers V, Harlan L, Stevens J (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97:134–147
New Zealand Health Information Service (2004) New Zealand cancer registry data dictionary. Ministry of Health, Wellington
Salmond C, Crampton P (2002) NZDep2001 index of deprivation—user’s manual. Wellington School of Medicine and Health Sciences, Wellington
Statistics New Zealand (1999) New Zealand now: women. Statistics New Zealand, Wellington
Curtis E, Wright C, Wall M (2005) The epidemiology of breast cancer in Maori women in Aotearoa New Zealand: implications for ethnicity data analysis. N Z Med J 118:1297–1306
Copeland KT, Checkoway H, McMichael AJ, Holbrook RH (1977) Bias due to misclassification in the estimation of relative risk. Am J Epidemiol 105:488–495
Merchant W, Millis R, Smith P, Chaudary M, Barnes D (1999) Expression of c-erbB-2 and p53 protein is similar in breast cancer from British and Japanese women. Int J Cancer 84:278–283
Choi D, Shin D, Lee M et al (2003) A comparison of five immunohistochemical biomarkers and HER-2/neu gene amplification by fluorescence in situ hybridization in white and korean patients with early-onset breast carcinoma. Cancer 98:1587–1595
Nichols H, Trentham-Dietz A, Love R et al (2005) Differences in breast cancer risk factors by tumour marker subtypes among premenopausal Vietnamese and Chinese women. Cancer Epidemiol Biomarkers Prev 14:41–7
Slamon D, Clark G, Wong S, Levin WJ, Ullrich A, McGuire WL (1987) Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 235:177–182
McCann A, Dervan P, O’Regan M et al (1991) Prognostic significance of c-erbB-2 and estrogen receptor status in human breast cancer. Cancer Res 51:3296–3303
Gordon NH (1995) Association of education and income with estrogen receptor status in primary breast cancer. Am J Epidemiol 142:796–803
Gordon NH (2003) Socioeconomic factors and breast cancer in black and white Americans. Cancer Metastasis Rev 22:55–65
Salmond C, Crampton P, King P, Waldegrave C (2006) NZiDep: a New Zealand index of socioeconomic deprivation for individuals. Soc Sci Med 62:1474–1485
Gold EB, Bromberger J, Crawford S et al (2001) Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am J Epidemiol 153:865–874
Loh FH, Khin LW, Saw SM, Lee JJ, Gu K (2005) The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study. Maturitas 52:169–180
Pearce N, Foliaki S, Sporle A, Cunningham C (2004) Genetics, race, ethnicity, and health. BMJ 328:1070–1072
Coates R, Clark W, Eley J, Greenberg RS, Huguley CM Jr, Brown RL (1990) Race, nutritional status, and survival from breast cancer. J Natl Cancer Inst 82:1684–1692
Ministry of Health (2004) A portrait of health: key results of the 2002/03 New Zealand Health Survey. Ministry of Health, Wellington
Acknowledgements
The authors would like to thank Susan Hanna and the staff at the Cancer Registry and New Zealand Health Information Service for providing data and assistance; and Dr Paul White and staff at Public Health Intelligence, Ministry of Health for matching Cancer Registry domicile codes to the New Zealand Deprivation Index 2001. The Centre for Public Health Research is supported by a Health Research Council programme grant.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McKenzie, F., Jeffreys, M., ’t Mannetje, A. et al. Prognostic factors in women with breast cancer: inequalities by ethnicity and socioeconomic position in New Zealand. Cancer Causes Control 19, 403–411 (2008). https://doi.org/10.1007/s10552-007-9099-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-007-9099-0