Division of Biostatistics and Epidemiology, Department of Medicine, College of Medicine, Medical University of South Carolina, and Hollings Cancer Center, 135 Cannon Street, Suite 300, Charleston, SC 29425, USA.
Breast Cancer Res Treat. 2013 Jan;137(2):589-98. doi: 10.1007/s10549-012-2305-0. Epub 2012 Dec 13.
Breast cancer mortality rates in South Carolina (SC) are 40 % higher among African-American (AA) than European-American (EA) women. Proposed reasons include race-associated variations in care and/or tumor characteristics, which may be subject to income effects. We evaluated race-associated differences in tumor biologic phenotype and stage among low-income participants in a government-funded screening program. Best Chance Network (BCN) data were linked with the SC Central Cancer Registry. Characteristics of breast cancers diagnosed in BCN participants aged 47-64 years during 1996-2006 were abstracted. Race-specific case proportions and incidence rates based on estrogen receptor (ER) status and histologic grade were estimated. Among 33,880 low-income women accessing BCN services, repeat breast cancer screening utilization was poor, especially among EAs. Proportionally, stage at diagnosis did not differ by race (607 cancers, 53 % among AAs), with about 40 % advanced stage. Compared to EAs, invasive tumors in AAs were 67 % more likely (proportions) to be of poor-prognosis phenotype (both ER-negative and high-grade); this was more a result of the 46 % lesser AA incidence (rates) of better-prognosis (ER+ lower-grade) cancer than the 32 % greater incidence of poor-prognosis disease (p values <0.01). When compared to the general SC population, racial disparities in poor-prognostic features within the BCN population were attenuated; this was due to more frequent adverse tumor features in EAs rather than improvements for AAs. Among low-income women in SC, closing the breast cancer racial and income mortality gaps will require improved early diagnosis, addressing causes of racial differences in tumor biology, and improved care for cancers of poor-prognosis biology.
南卡罗来纳州（SC）的乳腺癌死亡率在非裔美国女性（AA）中比在欧洲裔美国女性（EA）中高 40％。提出的原因包括与种族相关的护理差异和/或肿瘤特征，这可能受到收入的影响。我们评估了在政府资助的筛查计划中低收入参与者中与种族相关的肿瘤生物学表型和分期差异。Best Chance Network（BCN）的数据与 SC 中央癌症登记处相关联。从 1996 年至 2006 年在 BCN 参与者中诊断出的乳腺癌的特征被提取出来。根据雌激素受体（ER）状态和组织学分级，估算了按种族划分的乳腺癌病例比例和发病率。在 33880 名接受 BCN 服务的低收入女性中，重复进行乳腺癌筛查的利用率很差，尤其是在 EA 中。按比例计算，诊断时的分期并未因种族而异（607 例，AA 中的 53％），其中约有 40％为晚期。与 EA 相比，AA 中的浸润性肿瘤更有可能（比例）为预后不良的表型（ER 阴性和高级），这主要是由于 AA 中预后较好（ER+低级）癌症的发病率较低（比例）为 46％，而预后不良疾病的发病率较高（32％）（p 值<0.01）。与 SC 一般人群相比，BCN 人群中不良预后特征的种族差异减弱；这是由于 EA 中更频繁出现不良肿瘤特征，而不是 AA 中的改善。在 SC 的低收入女性中，要缩小乳腺癌的种族和收入死亡率差距，就需要改善早期诊断，解决肿瘤生物学种族差异的原因，并改善预后不良的癌症护理。
