Sariego Jack
Temple University School of Medicine, 7500 Central Avenue, Suite 201, Philadelphia, PA 19111, USA.
Am Surg. 2009 Jul;75(7):545-9; discussion 549-50. doi: 10.1177/000313480907500703.
Distribution of breast cancer varies widely throughout the United States. The factors that influence this geographic variability have not been completely defined. In addition, though a number of studies look at regional and state-to-state variability, few studies have examined this issue with regard to the nation as a whole. State-specific breast cancer data were available from the American College of Surgeons National Cancer Data Base in a series of Benchmark Reports. These data were reviewed and stratified with regard to: age at the time of presentation, race, and stage at the time of presentation. The data were further collected into regional cohorts that corresponded to the United States Census Bureau regions. Statistical analyses were then performed to identify any linked or related variables. A total of 811,652 patients with breast cancer were reported. There was a statistically significant relationship between stage at the time of presentation and census region. The greatest percentage of early-stage disease was recorded in the Northeast and the lowest in the South. There was no significant association between age at presentation and geographic region, but there was a significant relationship between race and stage. The nonwhite subgroup had a greater percentage of patients presenting with advanced-stage disease. Finally, regions with a larger percentage of nonurban population had a higher percentage of later-stage disease at presentation. A relationship exists between the pattern of breast cancer presentation and geographical location within the United States. The Northeast--with the highest percentage of urban areas and white population--reported the highest percentage of early-stage breast cancer at presentation, suggesting a link between these variables. Conversely, the South--with more rural and nonwhite population--had the highest percentage of later-stage disease. The causal relationships are not clear-cut, however, and the relationship between geography and breast cancer presentation is likely multifactorial. Further analysis is indicated to uncover any link between geographic variability and overall breast cancer treatment and survival.
乳腺癌在美国各地的分布差异很大。影响这种地理变异性的因素尚未完全明确。此外，尽管有许多研究关注地区和州与州之间的变异性，但很少有研究从整个国家的角度审视这个问题。美国外科医师学会国家癌症数据库在一系列基准报告中提供了各州特定的乳腺癌数据。这些数据根据就诊时的年龄、种族和就诊时的分期进行了审查和分层。数据进一步收集到与美国人口普查局区域相对应的区域队列中。然后进行统计分析以确定任何相关或关联的变量。共报告了811,652例乳腺癌患者。就诊时的分期与普查区域之间存在统计学上的显著关系。早期疾病比例最高的是东北部，最低的是南部。就诊时的年龄与地理区域之间没有显著关联，但种族与分期之间存在显著关系。非白人亚组中晚期疾病患者的比例更高。最后，非城市人口比例较高的地区就诊时晚期疾病的比例也较高。在美国，乳腺癌的就诊模式与地理位置之间存在关联。东北部城市地区和白人人口比例最高，报告的就诊时早期乳腺癌比例也最高，这表明这些变量之间存在联系。相反，南部农村和非白人人口较多，晚期疾病的比例最高，但因果关系并不明确，地理因素与乳腺癌就诊之间的关系可能是多因素的。需要进一步分析以揭示地理变异性与总体乳腺癌治疗和生存之间的任何联系。
