Factors That Contributed to Black-White Disparities in Survival Among Nonelderly Women With Breast Cancer Between 2004 and 2013

2018 ◽  
Vol 36 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Ahmedin Jemal ◽  
Anthony S. Robbins ◽  
Chun Chieh Lin ◽  
W. Dana Flanders ◽  
Carol E. DeSantis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormone Receptor ◽  
White Women ◽  
Early Stage ◽  
Excess Risk ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Tumor Characteristics ◽  
Cancer Data ◽  
Risk Of Death

Purpose To estimate the contribution of differences in demographics, comorbidity, insurance, tumor characteristics, and treatment to the overall mortality disparity between nonelderly black and white women diagnosed with early-stage breast cancer. Patients and Methods Excess relative risk of all-cause death in black versus white women diagnosed with stage I to III breast cancer, expressed as a percentage and stratified by hormone receptor status for each variable (demographics, comorbidity, insurance, tumor characteristics, and treatment) in sequentially, propensity-scored, optimally matched patients by using multivariable hazard ratios (HRs). Results We identified 563,497 white and black women 18 to 64 years of age diagnosed with stage I to III breast cancer from 2004 to 2013 in the National Cancer Data Base. Among women with hormone receptor–positive disease, who represented 78.5% of all patients, the HR for death in black versus white women in the demographics-matched model was 2.05 (95% CI, 1.94 to 2.17). The HR decreased to 1.93 (95% CI, 1.83 to 2.04), 1.54 (95% CI, 1.47 to 1.62), 1.30 (95% CI, 1.24 to 1.36), and 1.25 (95% CI, 1.19 to 1.31) when sequentially matched for comorbidity, insurance, tumor characteristics, and treatment, respectively. These factors combined accounted for 76.3% of the total excess risk of death in black patients; insurance accounted for 37.0% of the total excess, followed by tumor characteristics (23.2%), comorbidities (11.3%), and treatment (4.8%). Results generally were similar among women with hormone receptor–negative disease, although the HRs were substantially smaller. Conclusion Matching by insurance explained one third of the excess risk of death among nonelderly black versus white women diagnosed with early-stage breast cancer; matching by tumor characteristics explained approximately one fifth of the excess risk. Efforts to focus on equalization of access to care could substantially reduce ethnic/racial disparities in overall survival among nonelderly women diagnosed with breast cancer.

Black/White Disparities in Receipt of Treatment and Survival Among Men With Early-Stage Breast Cancer

2015 ◽  
Vol 33 (21) ◽  
pp. 2337-2344 ◽  
Author(s):  
Helmneh M. Sineshaw ◽  
Rachel A. Freedman ◽  
Elizabeth M. Ward ◽  
W. Dana Flanders ◽  
Ahmedin Jemal
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
White Men ◽  
Excess Risk ◽  
Early Stage Breast Cancer ◽  
Cancer Data ◽  
Risk Of Death

Purpose To examine the extent of black/white disparities in receipt of treatment and survival for early-stage breast cancer in men age 18 to 64 and ≥ 65 years. Patients and Methods We identified 725 non-Hispanic black (black) and 5,247 non-Hispanic white (white) men diagnosed with early-stage breast cancer from 2004 to 2011 in the National Cancer Data Base. We used multivariable logistic regression and calculated standardized risk ratios to predict receipt of treatment and a proportional hazards model to estimate overall hazard ratios (HRs) in black versus white men age 18 to 64 and ≥ 65 years, separately. Results Receipt of treatment was remarkably similar between blacks and whites in both age groups. Black and white older men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively). Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR, 1.76; 95% CI, 1.11 to 2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR, 1.37; 95% CI, 0.83 to 2.24). In those age ≥ 65 years, the excess risk of death in blacks versus whites was nonsignificant and not affected by adjustment for covariates. Conclusion The excess risk of death in black versus white men diagnosed with early-stage breast cancer was largely confined to those age 18 to 64 years and became nonsignificant after adjustment for differences in insurance and income. These findings suggest the importance of improving access to care in reducing racial disparities in male breast cancer mortality.

Axillary Radiotherapy in Conservative Surgery for Early-Stage Breast Cancer (Stage I and II)

2016 ◽  
Vol 94 (6) ◽  
pp. 331-338
Author(s):  
Alejandra García Novoa ◽  
Benigno Acea Nebril ◽  
Inma Díaz ◽  
Sergio Builes Ramírez ◽  
Cristina Varela ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Conservative Surgery ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Cancer Stage ◽  
Axillary Radiotherapy

scholarly journals Outcomes after Mastectomy and Lumpectomy in Octogenarians and Nonagenarians with Early-Stage Breast Cancer

2017 ◽  
Vol 83 (8) ◽  
pp. 887-894 ◽  
Author(s):  
Ameliay Merrill ◽  
Doris R. Brown ◽  
Heidi D. Klepin ◽  
Edward A. Levine ◽  
Marissa Howard-Mcnatt
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Local Treatment ◽  
Breast Conservation ◽  
Early Stage Breast Cancer ◽  
Risk Of Death ◽  
Increased Risk

Prospective studies have shown equal outcomes after mastectomy or breast conservation in patients with invasive breast cancer; however, many of these studies excluded elderly patients. We identified patients in their eighties and nineties with clinical stage 0 to II breast cancer undergoing mastectomy or lumpectomy with or without radiation from the prospective sentinel lymph node database at Wake Forest Baptist Health and analyzed their treatment and survival. Of 92 patients, 24 (26.1%) underwent mastectomy, 22 (23.9%) lumpectomy with radiation, and 46 (50.0%) lumpectomy alone. Significant differences were noted in tumor size (P = 0.018), nodal status (P = 0.013), and stage (P = 0.011) between the groups. Only 7.6 per cent of patients had chemotherapy, whereas 51.1 per cent took antiestrogen therapy. Recurrence occurred in 11 patients. In univariate analysis, overall survival did not differ by surgery. Age was the only factor that increased risk of death (HR = 1.19, P = 0.028). In this age group, neither tumor factors nor the type of local treatment significantly influenced overall survival. Octogenarians and nonagenarians with early-stage breast cancer undergoing breast-conserving surgery with or without radiation have equivalent survival to patients having a mastectomy.

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