Li A, Burton G, Glass J
Department of Pathology at Louisiana State University Health Science Center, Shreveport, USA.
J La State Med Soc. 2001 Aug;153(8):420-5.
A tumor registry data review on breast cancer populations seen at two hospitals in North Louisiana was completed in order to determine if race is independent of socioeconomic status (SES) factors related to breast cancer stage at diagnosis. The North Louisiana tumor registry identified 1183 patients diagnosed with breast cancer between 1987 and 1991, 304 patients from Louisiana State University Health Science Center (LSUHSC), a state supported hospital providing predominantly indigent care, and 879 patients from a private hospital (PH) serving predominantly insured patients. Hospital site was used as a proxy for SES (LSUHSC low, PH high). The patient populations differed significantly by age, racial makeup, and stage at presentation. Both white and African-American patients seen at PH had more stage 0 disease compared with LSUHSC (9.2% and 2.7%). White patients seen at PH had more stage I cancer as compared to white patients at LSUHSC (31.3% and 19.2%) or African-American patients at either PH or LSUHSC (19.4% and 19.9%). The frequency of stage III/IV cancer was higher in African-American patients at both LSUHSC (30.1%) and PH (29.0%) and white patients at LSUHSC (24.0%) as compared to white patients at PH (14.7%). Two hundred and nine patients were available for individual interview and specific definition of SES. LSUHSC patients were predominantly indigent (83% indigent and without insurance), while only 10% of PH patients lacked insurance. This study provides further support that the SES of white patients influences breast cancer stage at presentation. African-American patients, however, presented with more advanced breast cancer stages regardless of SES. Factors influencing African-American patient's disease stage are not limited to defined SES factors. Further studies are needed to define barriers and develop intervention strategies.
对路易斯安那州北部两家医院收治的乳腺癌患者群体进行了肿瘤登记数据审查，以确定种族是否独立于与乳腺癌诊断分期相关的社会经济地位（SES）因素。路易斯安那州北部肿瘤登记处确定了1987年至1991年间被诊断为乳腺癌的1183名患者，其中304名来自路易斯安那州立大学健康科学中心（LSUHSC），这是一家主要提供贫困医疗服务的州立医院，另外879名来自一家主要服务于参保患者的私立医院（PH）。医院地点被用作SES的替代指标（LSUHSC代表低SES，PH代表高SES）。患者群体在年龄、种族构成和就诊时的分期方面存在显著差异。与LSUHSC相比，在PH就诊的白人和非裔美国患者中0期疾病更多（分别为9.2%和2.7%）。与LSUHSC的白人患者（19.2%）或PH及LSUHSC的非裔美国患者（19.9%）相比，在PH就诊的白人患者I期癌症更多（31.3%）。与PH的白人患者（14.7%）相比，LSUHSC的非裔美国患者（30.1%）和PH的非裔美国患者（29.0%）以及LSUHSC的白人患者（24.0%）中III/IV期癌症的发生率更高。209名患者可接受个人访谈并对SES进行具体定义。LSUHSC的患者主要是贫困人口（83%为贫困人口且无保险），而PH的患者中只有10%没有保险。这项研究进一步支持了白人患者的SES会影响就诊时乳腺癌分期这一观点。然而，无论SES如何，非裔美国患者就诊时的乳腺癌分期更晚。影响非裔美国患者疾病分期的因素不限于已定义的SES因素。需要进一步研究来确定障碍并制定干预策略。
