Divisions of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA,
Med Oncol. 2013 Dec;30(4):691. doi: 10.1007/s12032-013-0691-8. Epub 2013 Aug 22.
Racial and ethnic minority patients continue to die disproportionately from breast cancer compared with their white counterparts, even after adjusting for insurance status and income. No studies have examined whether surveillance mammography reduces racial disparities in survival among elderly breast cancer survivors following active treatment for breast cancer. This study included 28,117 cases diagnosed with primary breast cancer at age 66 years and over, identified from SEER data during 1992-2005. Kaplan-Meier methods and Cox regression models were used for survival analysis. A higher proportion of whites received surveillance mammograms during the surveillance period compared with nonwhites: 71.7% of African-Americans, 72.5% of Hispanics, and 69.3% of Asians had mammograms compared with 74.9% of whites. In propensity-score-adjusted analysis, women who had a mammogram within 2 years were less likely (hazard ratio 0.84; 95% CI 0.78-0.82) to die from any cause compared with women who did not have any mammograms during this time period. The hazard ratio of cancer-specific mortality elevated for Hispanics compared with whites (hazard ratio 1.5; 95% CI 0.6-3.2) and was reduced after adjusting for surveillance mammography (hazard ratio 1.4; 95% CI 0.5-2.9). Similar pattern in the reduction in disease-specific hazard ratio was observed for blacks: After controlling for patient and tumor characteristics, hazard ratio was elevated but not significantly different from that in whites (hazard ratio 2.0; 95% CI 0.9-3.7), and hazard ratio adjusting for surveillance mammography further reduced the point estimate (hazard ratio 1.5; 95% CI 0.7-2.8). Asian and Pacific Islanders and Hispanics appeared to have lower risks of all-cause mortality compared with whites after controlling for patient and tumor characteristics and surveillance mammogram received. Our findings indicates that while surveillance mammograms and physician visits may play a contributory role in achieving equal outcomes for breast cancer-specific mortality for women with breast cancer, searching for other factors that might help achieve national goals to eliminate racial disparities in healthcare, and outcomes is warranted.
与白人患者相比，少数族裔患者在接受乳腺癌治疗后仍然不成比例地死于乳腺癌，即使在调整了保险状况和收入后也是如此。目前还没有研究探讨监测性乳房 X 光检查是否可以降低接受乳腺癌积极治疗后的老年乳腺癌幸存者的生存中的种族差异。本研究纳入了 1992 年至 2005 年期间从 SEER 数据中确定的 28117 例年龄在 66 岁及以上、诊断为原发性乳腺癌的患者。使用 Kaplan-Meier 方法和 Cox 回归模型进行生存分析。与非白人患者相比，白人患者在监测期间接受监测性乳房 X 光检查的比例更高：71.7%的非裔美国人、72.5%的西班牙裔和 69.3%的亚裔患者接受了乳房 X 光检查，而白人患者的这一比例为 74.9%。在倾向评分调整分析中，在 2 年内进行过乳房 X 光检查的女性与在此期间未进行任何乳房 X 光检查的女性相比，死于任何原因的可能性更低（风险比 0.84；95%CI 0.78-0.82）。与白人相比，西班牙裔的癌症特异性死亡率风险比升高（风险比 1.5；95%CI 0.6-3.2），但在调整监测性乳房 X 光检查后风险比降低（风险比 1.4；95%CI 0.5-2.9）。对于黑人，也观察到疾病特异性风险比降低的相似模式：在控制患者和肿瘤特征后，风险比升高，但与白人相比无统计学差异（风险比 2.0；95%CI 0.9-3.7），并且通过调整监测性乳房 X 光检查进一步降低了点估计值（风险比 1.5；95%CI 0.7-2.8）。亚洲和太平洋岛民以及西班牙裔与白人相比，在控制患者和肿瘤特征以及接受监测性乳房 X 光检查后，全因死亡率的风险似乎更低。我们的研究结果表明，虽然监测性乳房 X 光检查和医生就诊可能在实现乳腺癌特异性死亡率的平等结果方面为乳腺癌女性做出了贡献，但寻找其他可能有助于实现消除医疗保健和结果中的种族差异的国家目标的因素是合理的。
