Li Christopher I, Malone Kathleen E, Daling Janet R
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, MP 381, PO Box 19024, Seattle, WA 98109-1024, USA.
Arch Intern Med. 2003 Jan 13;163(1):49-56. doi: 10.1001/archinte.163.1.49.
In the United States, black and Hispanic white women with breast cancer present with more advanced stages and have poorer survival rates than non-Hispanic whites, whereas Asians and Pacific Islanders do not. However, Asians and Pacific Islanders and Hispanic whites are heterogeneous populations, and few studies have evaluated breast cancer stage, treatments, and mortality rates for subgroups of these populations.
Using data from 11 population-based tumor registries that participate in the Surveillance, Epidemiology, and End Results Program, we conducted a retrospective cohort study to evaluate the relationship between race and ethnicity and breast cancer stage, treatments, and mortality rates. The cohort of 124,934 women diagnosed as having a first primary invasive breast carcinoma between January 1, 1992, and December 31, 1998, included 97,999 non-Hispanic whites, 10,560 blacks, 322 American Indians, 8834 Asians and Pacific Islanders, and 7219 Hispanic whites.
Relative to non-Hispanic whites, blacks, American Indians, Hawaiians, Indians and Pakistanis, Mexicans, South and Central Americans, and Puerto Ricans had 1.4- to 3.6-fold greater risks of presenting with stage IV breast cancer. Blacks, Mexicans, and Puerto Ricans were 20% to 50% more likely to receive or elect a first course of surgical and radiation treatment not meeting the 2000 National Comprehensive Cancer Network standards. In addition, blacks, American Indians, Hawaiians, Vietnamese, Mexicans, South and Central Americans, and Puerto Ricans had 20% to 200% greater risks of mortality after a breast cancer diagnosis.
Differences in breast cancer stage, treatments, and mortality rates are present by race and ethnicity. Breast cancer survival may be improved by targeting factors, particularly socioeconomic factors, that underlie these differences.
在美国，患有乳腺癌的黑人女性和西班牙裔白人女性相较于非西班牙裔白人，就诊时癌症分期更晚，生存率更低，而亚裔和太平洋岛民则不然。然而，亚裔和太平洋岛民以及西班牙裔白人是异质群体，很少有研究评估这些群体亚组的乳腺癌分期、治疗情况及死亡率。
利用参与监测、流行病学和最终结果计划的11个基于人群的肿瘤登记处的数据，我们开展了一项回顾性队列研究，以评估种族和族裔与乳腺癌分期、治疗情况及死亡率之间的关系。该队列包括1992年1月1日至1998年12月31日期间被诊断为患有首例原发性浸润性乳腺癌的124,934名女性，其中有97,999名非西班牙裔白人、10,560名黑人、322名美洲印第安人、8834名亚裔和太平洋岛民以及7219名西班牙裔白人。
相对于非西班牙裔白人，黑人、美洲印第安人、夏威夷人、印度人和巴基斯坦人、墨西哥人、南美洲和中美洲人以及波多黎各人患IV期乳腺癌的风险高1.4至3.6倍。黑人、墨西哥人和波多黎各人接受或选择不符合2000年国家综合癌症网络标准的首个手术和放射治疗疗程的可能性要高20%至50%。此外，黑人、美洲印第安人、夏威夷人、越南人、墨西哥人、南美洲和中美洲人以及波多黎各人在乳腺癌诊断后的死亡风险要高20%至200%。
乳腺癌分期、治疗情况和死亡率在种族和族裔方面存在差异。针对造成这些差异的因素，尤其是社会经济因素，可能会提高乳腺癌生存率。
