Abstract
Purpose
A survival disparity of black versus white breast cancer patients has been extensively documented but not adequately explained. Blacks and whites also have significant differences in hematologic traits including hemoglobin (HGB). However, a link between survival disparity and hematologic differences has not been reported. We aimed to explore the effect of pre-treatment hematologic variables on this survival disparity.
Methods
We sequentially matched 443 black patients, using a minimum distance approach, to four different sets of 443 whites on demographics (age, year of diagnosis, smoking, and drinking status), tumor presentation (all demographic variables plus tumor stage, grade, and hormone receptor status), treatment (all presentation variables plus surgery, chemotherapy, radiation therapy, and hormone therapy), and presentation plus pre-treatment hematologic variables. Racial survival for each matched dataset was analyzed by Cox proportional hazards model.
Results
We found that white patients matched on demographic characteristics had more favorable survival than blacks [hazard ratio (HR) 0.57, 95 % confidence interval (CI) 0.42–0.77, p log-rank = 0.0002]. Presentation match diminished this disparity [HR 0.72 (0.54–0.95), p log-rank = 0.0199], which was not further reduced in treatment match [HR 0.73 (0.55–0.96), p log-rank = 0.0249]. However, the survival disparity was largely reduced when pre-treatment level of HGB or red blood cell distribution width was further matched in addition to presentation match [HR 0.83 (0.64–1.09), p log-rank = 0.1819 and HR 0.83 (0.64–1.09), p log-rank = 0.1760, respectively].
Conclusions
We found that in our patient population, differences in tumor presentation and certain pre-treatment hematologic traits, but not treatment, were associated with the survival disparity between black and white breast cancer patients.
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Abbreviations
- HGB:
-
Hemoglobin
- HR:
-
Hazard ratio
- CI:
-
Confidence interval
- RDW:
-
Red blood cell distribution width
- SEER:
-
Surveillance, epidemiology, and end results
- SES:
-
Socioeconomic status
- HCT:
-
Hematocrit
- MCH:
-
Mean corpuscular hemoglobin
- MCHC:
-
MCH concentration
- MCV:
-
Mean corpuscular volume
- RBC:
-
Red blood cell
- WBC:
-
White blood cell
- CBC:
-
Complete blood count
- ER:
-
Estrogen receptor
- PR:
-
Progesterone receptor
- AJCC:
-
American Joint Committee on Cancer
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Acknowledgments
The work was supported by a start-up fund from Thomas Jefferson University, and a Research Scholar Grant from the V Foundation for Cancer Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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The authors declare that they have no conflict of interest.
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Wang, C., Civan, J., Lai, Y. et al. Racial disparity in breast cancer survival: the impact of pre-treatment hematologic variables. Cancer Causes Control 26, 45–56 (2015). https://doi.org/10.1007/s10552-014-0481-4
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DOI: https://doi.org/10.1007/s10552-014-0481-4