Harper Sam, Lynch John, Meersman Stephen C, Breen Nancy, Davis William W, Reichman Marsha C
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Room 34, Montreal, Quebec, Canada H3A 1A2.
Cancer Epidemiol Biomarkers Prev. 2009 Jan;18(1):121-31. doi: 10.1158/1055-9965.EPI-08-0679.
Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States and varies systematically by race-ethnicity and socioeconomic status. Previous research has often focused on disparities between particular groups, but few studies have summarized disparities across multiple subgroups defined by race-ethnic and socioeconomic position.
Data on breast cancer incidence, stage, mortality, and 5-year cause-specific probability of death (100 - survival) were obtained from the Surveillance, Epidemiology, and End Results program and data on mammography screening from the National Health Interview Survey from 1987 to 2005. We used four area-socioeconomic groups based on the percentage of poverty in the county of residence (<10, 10-15, 15-20, +20%) and five race-ethnic groups (White, Black, Asian, American Indian, and Hispanic). We used summary measures of disparity based on both rate differences and rate ratios.
From 1987 to 2004, area-socioeconomic disparities declined by 20% to 30% for incidence, stage at diagnosis, and 5-year cause-specific probability of death, and by roughly 100% for mortality, whether measured on the absolute or relative scale. In contrast, relative area-socioeconomic disparities in mammography use increased by 161%. Absolute race-ethnic disparities declined across all outcomes, with the largest reduction for mammography (56% decline). Relative race-ethnic disparities for mortality and 5-year cause-specific probability of death increased by 24% and 17%, respectively.
Our analysis suggests progress towards race-ethnic and area-socioeconomic disparity goals for breast cancer, especially when measured on the absolute scale. However, greater progress is needed to address increasing relative socioeconomic disparities in mammography and race-ethnic disparities in mortality and 5-year cause-specific probability of death.
乳腺癌是美国女性中最常被诊断出的癌症，也是癌症死亡的第二大主要原因，并且在种族和社会经济地位方面存在系统性差异。以往的研究通常聚焦于特定群体之间的差异，但很少有研究总结过由种族和社会经济地位定义的多个亚组之间的差异。
从监测、流行病学和最终结果项目中获取乳腺癌发病率、分期、死亡率以及5年特定病因死亡概率（100 - 生存率）的数据，并从1987年至2005年的国家健康访谈调查中获取乳房X光检查筛查的数据。我们根据居住县的贫困百分比（<10%、10 - 15%、15 - 20%、+20%）划分了四个地区社会经济群体，以及五个种族群体（白人、黑人、亚洲人、美国印第安人和西班牙裔）。我们使用了基于率差和率比的差异汇总指标。
从1987年到2004年，无论从绝对还是相对尺度衡量，地区社会经济差异在发病率、诊断分期和5年特定病因死亡概率方面下降了20%至30%，在死亡率方面下降了约100%。相比之下，乳房X光检查使用方面的相对地区社会经济差异增加了161%。所有结果的绝对种族差异均有所下降，乳房X光检查下降幅度最大（下降了56%）。死亡率和5年特定病因死亡概率的相对种族差异分别增加了24%和17%。
我们的分析表明在乳腺癌的种族和地区社会经济差异目标方面取得了进展，尤其是在绝对尺度衡量时。然而，需要取得更大进展以解决乳房X光检查中日益增加的相对社会经济差异以及死亡率和5年特定病因死亡概率方面的种族差异。
