O'Malley Cynthia D, Le Gem M, Glaser Sally L, Shema Sarah J, West Dee W
Northern California Cancer Center, Union City, California 94587, USA.
Cancer. 2003 Mar 1;97(5):1303-11. doi: 10.1002/cncr.11160.
Although overall survival for invasive breast carcinoma remains high, black women experience poorer survival than whites. Less is known about the survival of Hispanics and Asians, who may share clinical and socioeconomic risk factors similar to blacks. To better understand racial/ethnic survival patterns, we investigated the effect of socioeconomic status (SES) and disease stage on racial/ethnic differences in breast carcinoma survival in a large population-based cohort.
Using data from the Surveillance, Epidemiology, and End Results program (SEER), we identified 10,414 white, 940 black, 1100 Hispanic, and 1180 Asian females diagnosed with breast carcinoma in the Greater San Francisco Bay Area between 1988 and 1992. We used the Kaplan-Meier method to generate survival rates and Cox proportional hazards regression to estimate the risk of death by race/ethnicity, after adjustment for clinical, demographic, and census-derived SES variables.
The 10-year unadjusted survival rates were 81% for whites, 69% for blacks, 75% for Hispanics, and 79% for Asians. Adjusting for stage decreased the relative risk of mortality for blacks from 1.81 to 1.29; the stage-adjusted relative risk for Hispanics (1.11) and Asians (1.02) did not differ significantly from whites. Additional adjustment for age, tumor characteristics, and treatment factors did little to alter the relative risk in blacks; adding blue-collar status to the model further decreased the relative risks for blacks to 1.22. Residing in a blue-collar neighborhood was independently associated with a 1.16 increase in risk of death.
After adjustment for multiple factors, blacks continue to have slight but significantly poorer survival after breast carcinoma compared with whites, whereas the survival of Hispanics and Asians did not differ from whites.
尽管浸润性乳腺癌患者的总体生存率仍然较高，但黑人女性的生存率低于白人。对于西班牙裔和亚裔女性的生存率了解较少，她们可能与黑人有着相似的临床和社会经济风险因素。为了更好地理解种族/族裔的生存模式，我们在一个大型人群队列中研究了社会经济地位（SES）和疾病分期对乳腺癌患者种族/族裔生存差异的影响。
利用监测、流行病学和最终结果计划（SEER）的数据，我们确定了1988年至1992年间在旧金山湾区被诊断为乳腺癌的10414名白人、940名黑人、1100名西班牙裔和1180名亚裔女性。我们使用Kaplan-Meier方法生成生存率，并使用Cox比例风险回归来估计经临床、人口统计学和基于人口普查的SES变量调整后按种族/族裔划分的死亡风险。
未调整的10年生存率白人是81%，黑人是69%，西班牙裔是75%，亚裔是79%。调整分期后，黑人的相对死亡风险从1.81降至1.29；西班牙裔（1.11）和亚裔（1.02）经分期调整后的相对风险与白人无显著差异。对年龄、肿瘤特征和治疗因素进行进一步调整对黑人的相对风险影响不大；在模型中加入蓝领身份进一步将黑人的相对风险降至1.22。居住在蓝领社区与死亡风险增加1.16独立相关。
在对多个因素进行调整后，与白人相比，黑人乳腺癌患者的生存率仍然略低但显著较差，而西班牙裔和亚裔的生存率与白人没有差异。
