Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
Breast Cancer Res Treat. 2010 Jun;121(3):743-51. doi: 10.1007/s10549-009-0643-3. Epub 2009 Dec 1.
Research has shown that Hispanic women in the United States are diagnosed with breast cancer at more advanced stages and initiate treatment later than non-Hispanic white women. We investigated whether stage at breast cancer diagnosis and receipt of primary therapy differ by ethnicity and birthplace among US-born Hispanic, foreign-born Hispanic, and white women. We studied 31,012 Hispanic women and 372,313 white women with a first diagnosis of invasive breast cancer during 1988 and 2005 living in a SEER area. We used multinomial logistic regression to assess the association of ethnicity and birthplace with stage at diagnosis and, among women with stage I or II cancers, primary therapy [mastectomy, breast-conserving surgery (BCS) with radiation, BCS without radiation], adjusting for other patient and tumor characteristics. Rates of stage at diagnosis differed significantly by race/ethnicity and birthplace (P < 0.001). Foreign-born Hispanics had lower adjusted rates of stage I breast cancer at diagnosis (35.4%) than US-born Hispanics (40.6%), birthplace-unknown Hispanics (42.3%), and whites (47.4%). Receipt of primary therapy also differed significantly by race/ethnicity and birthplace (P < 0.001). Foreign-born Hispanics and birthplace-unknown Hispanics had lower rates of BCS with radiation (34.9%, 30.7%) than US-born Hispanics (41.5%) and whites (38.8%). Foreign-born Hispanic women in the United States have a lower probability of being diagnosed at earlier stages of breast cancer and, for women with early-stage disease, of receiving radiation following BCS compared to US-born Hispanics and whites. Identifying factors mediating these disparities may help in developing culturally and linguistically appropriate interventions and improving outcomes.
研究表明，与非西班牙裔白人女性相比，美国的西班牙裔女性被诊断出患有乳腺癌的阶段更晚，并且开始治疗的时间也更晚。我们调查了在美国出生的西班牙裔、外国出生的西班牙裔和白人女性中，种族和出生地是否会影响乳腺癌的诊断阶段和接受主要治疗的情况。我们研究了 1988 年至 2005 年间居住在 SEER 地区的 31012 名西班牙裔女性和 372313 名白人女性，她们被诊断出患有浸润性乳腺癌。我们使用多项逻辑回归来评估种族和出生地与诊断时的阶段之间的关联，并且对于患有 I 期或 II 期癌症的女性，评估主要治疗方法（乳房切除术、保乳手术伴放疗、保乳手术不伴放疗），调整其他患者和肿瘤特征。诊断阶段的比率因种族/族裔和出生地而异（P<0.001）。外国出生的西班牙裔女性诊断为 I 期乳腺癌的调整后比率（35.4%）低于美国出生的西班牙裔女性（40.6%）、出生地未知的西班牙裔女性（42.3%）和白人女性（47.4%）。主要治疗方法的接受情况也因种族/族裔和出生地而异（P<0.001）。外国出生的西班牙裔和出生地未知的西班牙裔女性接受保乳手术伴放疗的比例（34.9%，30.7%）低于美国出生的西班牙裔女性（41.5%）和白人女性（38.8%）。与美国出生的西班牙裔和白人女性相比，在美国的外国出生的西班牙裔女性被诊断出患有乳腺癌的阶段更早，并且对于患有早期疾病的女性，在接受保乳手术后接受放疗的可能性也更低。确定导致这些差异的因素可能有助于制定文化和语言适宜的干预措施，从而改善治疗效果。
