Schootman Mario, Jeffe Donna B, Gillanders William E, Aft Rebecca
Department of Medicine, Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, Missouri 63108, USA.
Cancer. 2009 Feb 15;115(4):731-40. doi: 10.1002/cncr.24087.
Distant metastases are the most common and lethal type of breast cancer relapse. The authors examined whether older African American breast cancer survivors were more likely to develop metastases compared with older white women. They also examined the extent to which 6 pathways explained racial disparities in the development of metastases.
The authors used 1992-1999 Surveillance, Epidemiology, and End Results (SEER) data with 1991-1999 Medicare data. They used Medicare's International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify metastases of respiratory and digestive systems, brain, bone, or other unspecified sites. The 6 pathways consisted of patient characteristics, tumor characteristics, type of treatment received, access to medical care, surveillance mammography use, and area-level characteristics (poverty rate and percentage African American) and were obtained from the SEER or Medicare data.
Of the 35,937 women, 10.5% developed metastases. In univariate analysis, African American women were 1.61 times (95% confidence interval [CI], 1.54-1.83) more likely to develop metastasis than white women. In multivariate analysis, tumor grade, stage at diagnosis, and census-tract percentage African American explained why African American women were more likely to develop metastases than white women (hazard ratio, 0.84; 95% CI, 0.68-1.03).
Interventions to reduce late-stage breast cancer among African Americans also may reduce racial disparities in subsequent increased risk of developing metastasis. African Americans diagnosed with high-grade breast cancer could be targeted to reduce their risk of metastasis. Future studies should identify specific reasons why the racial distribution in census tracts was associated with racial disparities in the risk of breast cancer metastases.
远处转移是乳腺癌复发最常见且致命的类型。作者研究了老年非裔美国乳腺癌幸存者与老年白人女性相比是否更易发生转移。他们还研究了6种途径在多大程度上解释了转移发生方面的种族差异。
作者使用了1992 - 1999年监测、流行病学和最终结果（SEER）数据以及1991 - 1999年医疗保险数据。他们使用医疗保险的《国际疾病分类，第九修订版，临床修订本》编码来识别呼吸和消化系统、脑、骨或其他未指明部位的转移。这6种途径包括患者特征、肿瘤特征、接受的治疗类型、获得医疗服务的情况、乳腺钼靶筛查的使用以及地区层面特征（贫困率和非裔美国人百分比），这些数据来自SEER或医疗保险数据。
在35937名女性中，10.5%发生了转移。在单因素分析中，非裔美国女性发生转移的可能性是白人女性的1.61倍（95%置信区间[CI]，1.54 - 1.83）。在多因素分析中，肿瘤分级、诊断时的分期以及普查区非裔美国人百分比解释了为什么非裔美国女性比白人女性更易发生转移（风险比，0.84；95%CI，0.68 - 1.03）。
减少非裔美国人晚期乳腺癌的干预措施也可能减少后续转移风险增加方面的种族差异。可针对被诊断为高级别乳腺癌的非裔美国人来降低其转移风险。未来的研究应确定普查区的种族分布与乳腺癌转移风险的种族差异相关的具体原因。
