Gomez Scarlett L, France Anne-Marie, Lee Marion M
Northern California Cancer Center, Union City, CA 94587, USA.
Ethn Dis. 2004 Winter;14(1):134-40.
Previous studies have demonstrated substantial variations in breast conserving surgery (BCS) across sociodemographic groups. This study explored the joint influences of socioeconomic, immigration/acculturation, and clinical factors on ethnic differences in breast cancer surgery for early-stage disease.
The study used interview data for 297 women, under the age of 70, who resided in the San Francisco Bay area, and had been diagnosed with primary early-stage breast cancer (carcinoma in-situ or invasive) between January 1990 and December 1992.
The proportion of patients who either had undergone BCS or had no surgery was 45%, 20%, 45%, and 34%, among Whites, Chinese, Blacks, and Hispanics, respectively. The proportion of patients diagnosed at in-situ or localized stages, with tumors of less than 4 centimeters, was higher among those who received BCS or no surgery, compared to those who had undergone a mastectomy. White women who received BCS/no surgery tended to be younger than their counterparts who underwent mastectomies, but Chinese and Black women who received BCS/no surgery were older. The proportion of women diagnosed in smaller, private hospitals was higher among those receiving BCS/no surgery, although these associations varied by ethnicity. Women who had undergone BCS/no surgery were characterized as being of higher socioeconomic status, more acculturated, and less likely to be recent immigrants. In a multivariate regression model adjusting for clinical, socioeconomic, and immigration/acculturation factors, Chinese women were more likely than Whites to have a mastectomy, rather than BCS/no surgery (odds ratio, 2.8; 95% confidence interval, 1.0-7.8).
Use of BCS or no surgery was associated with various clinical, socioeconomic, and immigration/acculturation characteristics, although some of the associations varied by ethnicity. However, these factors did not account for the reduced presence of BCS, or no surgery, among Chinese women.
以往研究表明，保乳手术（BCS）在不同社会人口学群体中存在显著差异。本研究探讨了社会经济、移民/文化适应和临床因素对早期乳腺癌手术种族差异的联合影响。
该研究使用了对297名70岁以下女性的访谈数据，这些女性居住在旧金山湾区，于1990年1月至1992年12月期间被诊断为原发性早期乳腺癌（原位癌或浸润性癌）。
接受保乳手术或未接受手术的患者比例在白人、华裔、黑人和西班牙裔中分别为45%、20%、45%和34%。与接受乳房切除术的患者相比，接受保乳手术或未接受手术的患者中，原位癌或局部阶段、肿瘤小于4厘米的诊断比例更高。接受保乳手术/未接受手术的白人女性往往比接受乳房切除术的同龄人年轻，但接受保乳手术/未接受手术的华裔和黑人女性年龄更大。在接受保乳手术/未接受手术的患者中，在较小的私立医院诊断的女性比例更高，尽管这些关联因种族而异。接受保乳手术/未接受手术的女性具有社会经济地位较高、文化适应程度较高且近期移民可能性较小的特征。在调整了临床、社会经济和移民/文化适应因素的多变量回归模型中，华裔女性比白人更有可能接受乳房切除术，而不是保乳手术/未接受手术（优势比，2.8；95%置信区间，1.0 - 7.8）。
保乳手术或未接受手术的使用与各种临床、社会经济和移民/文化适应特征相关，尽管其中一些关联因种族而异。然而，这些因素并不能解释华裔女性中保乳手术或未接受手术比例较低的原因。
