Coates R J, Bransfield D D, Wesley M, Hankey B, Eley J W, Greenberg R S, Flanders D, Hunter C P, Edwards B K, Forman M
Epidemiology Division, Emory University School of Public Health, Atlanta, Ga. 30329.
J Natl Cancer Inst. 1992 Jun 17;84(12):938-50. doi: 10.1093/jnci/84.12.938.
Studies in the United States have reported that Black women have higher fatality rates than White women following a diagnosis of breast cancer and are more likely to be diagnosed with late-stage cancers.
To evaluate reasons for these racial differences, we explored the difference between Black and White women in the length of time from symptom recognition to initial medical consultation. We also evaluated the extent to which other factors related to the length of this interval might contribute to any observed racial difference.
As part of a collaborative study of differences in the survival rates of Black patients and White patients with cancer, we interviewed a sample of 410 Black women and 325 White women from Atlanta, New Orleans, and San Francisco/Oakland who were newly diagnosed in 1985 or 1986 with invasive breast cancer. Retrospective data were collected on symptoms, dates of symptom recognition and initial medical consultation, and several other factors which may affect the interval between symptom recognition and medical consultation. Data were analyzed as if from a follow-up study, using product limit procedures and proportional hazards regression.
At diagnosis, Black women with breast cancer were two times more likely to have stage IV breast cancer and one and one-half times more likely to have stage III breast cancer than White women with breast cancer and were only approximately one-half as likely to have stage I breast cancer. Similarly, Black women were almost twice as likely as White women to have tumors that were larger than 5 cm or tumors that had extensions to the chest wall or skin at presentation. However, the average rate at which Black women with breast cancer obtained an initial medical consultation lagged behind that for White women by only a slight but statistically significant difference (15%). The median time between symptom recognition and medical consultation was slightly longer for Black women (16 days) than for White women (14 days) (P = .06). Adjustment for other characteristics predictive of the length of this interval had little effect on racial differences. The racial differences tended to vary somewhat by age and metropolitan area, suggesting that the results may not apply equally to all demographic subgroups and regions in the United States.
This small difference in the time from symptom recognition to medical consultation is unlikely to account for the large racial differences in survival rates and in stage of disease at the time of diagnosis.
美国的研究报告称，黑人女性在被诊断出患有乳腺癌后的死亡率高于白人女性，且更有可能被诊断为晚期癌症。
为评估这些种族差异的原因，我们探讨了黑人女性与白人女性从症状识别到首次就医咨询的时间长度差异。我们还评估了与这段间隔时间长度相关的其他因素在多大程度上可能导致观察到的种族差异。
作为一项关于癌症患者中黑人和白人存活率差异的合作研究的一部分，我们采访了410名黑人女性和325名白人女性，她们来自亚特兰大、新奥尔良以及旧金山/奥克兰，于1985年或1986年新诊断出患有浸润性乳腺癌。收集了关于症状、症状识别日期和首次就医咨询日期以及其他可能影响症状识别与就医咨询间隔时间的因素的回顾性数据。数据采用乘积限法和比例风险回归进行分析，就如同来自一项随访研究。
在诊断时，患有乳腺癌的黑人女性患IV期乳腺癌的可能性是患有乳腺癌的白人女性的两倍，患III期乳腺癌的可能性是白人女性的1.5倍，而患I期乳腺癌的可能性仅约为白人女性的一半。同样，黑人女性患肿瘤大于5厘米或肿瘤在就诊时已侵犯胸壁或皮肤的可能性几乎是白人女性的两倍。然而，患有乳腺癌的黑人女性获得首次就医咨询的平均速度仅比白人女性落后一个轻微但具有统计学意义的差异（15%）。黑人女性从症状识别到就医咨询的中位时间（16天）略长于白人女性（14天）（P = 0.06）。对其他预测这段间隔时间长度的特征进行调整，对种族差异影响不大。种族差异在年龄和大都市区有所不同，这表明结果可能并不适用于美国所有人口亚组和地区。
从症状识别到就医咨询的时间上的这一微小差异不太可能解释存活率和诊断时疾病分期方面存在的巨大种族差异。
