Worthington Julie, Waterbor John W, Funkhouser Ellen, Falkson Carla, Cofield Stacey, Fouad Mona
Division of Gastroenterology, Case Western Reserve University, Cleveland, OH, USA.
Int J Med Sci. 2008 Jul 7;5(4):181-8. doi: 10.7150/ijms.5.181.
Breast cancer mortality is higher among African Americans than for Whites, though their breast cancer incidence is lower. This study examines whether this disparity may be due to differential receipt of treatment defined as "standard of care" or "addition to standard of care" by the National Comprehensive Cancer Network (NCCN).
Incident, female breast cancer cases, 2,203 African American and 7,518 White, diagnosed during 1996-2002 were identified from the Alabama Statewide Cancer Registry. Breast cancer treatment was characterized as whether or not a woman received standard of care as defined by the NCCN. For cases characterized as receiving standard of care, addition to standard of care was also evaluated, defined as receiving at least one additional treatment modality according to NCCN guidelines. Logistic models were used to evaluate racial differences in standard and addition to standard of care and to adjust for age, stage at diagnosis, year of diagnosis and area of residence.
No racial differences were found for standard (Prevalence Ratio (PR)=1.00) or for addition to standard of care (PR=1.00) after adjustment for confounders. When the adjusted models were examined separately by age, stage, and area of residence, overall no racial differences were found.
No racial differences in standard of care and addition to standard of care for breast cancer treatment were found. Therefore, both African Americans and Whites received comparable treatment according to NCCN guidelines.
非裔美国人的乳腺癌死亡率高于白人,尽管他们的乳腺癌发病率较低。本研究探讨这种差异是否可能归因于接受国家综合癌症网络(NCCN)定义的“标准治疗”或“标准治疗之外的附加治疗”的差异。
从阿拉巴马州全州癌症登记处识别出1996年至2002年期间确诊的2203例非裔美国女性和7518例白人女性乳腺癌新发病例。乳腺癌治疗的特征是女性是否接受了NCCN定义的标准治疗。对于被认定接受标准治疗的病例,还评估了标准治疗之外的附加治疗,定义为根据NCCN指南接受至少一种额外的治疗方式。使用逻辑模型评估标准治疗以及标准治疗之外附加治疗的种族差异,并对年龄、诊断时的分期、诊断年份和居住地区进行调整。
在对混杂因素进行调整后,标准治疗(患病率比(PR)=1.00)或标准治疗之外的附加治疗(PR=1.00)均未发现种族差异。当按年龄、分期和居住地区分别检查调整后的模型时,总体上未发现种族差异。
在乳腺癌治疗的标准治疗和标准治疗之外的附加治疗方面未发现种族差异。因此,根据NCCN指南,非裔美国人和白人接受了类似的治疗。