Helmneh M. Sineshaw, Elizabeth M. Ward, W. Dana Flanders, and Ahmedin Jemal, American Cancer Society; W. Dana Flanders, Rollins School of Public Health, Emory University, Atlanta, GA; and Rachel A. Freedman, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA.
J Clin Oncol. 2015 Jul 20;33(21):2337-44. doi: 10.1200/JCO.2014.60.5584. Epub 2015 May 4.
To examine the extent of black/white disparities in receipt of treatment and survival for early-stage breast cancer in men age 18 to 64 and ≥ 65 years.
We identified 725 non-Hispanic black (black) and 5,247 non-Hispanic white (white) men diagnosed with early-stage breast cancer from 2004 to 2011 in the National Cancer Data Base. We used multivariable logistic regression and calculated standardized risk ratios to predict receipt of treatment and a proportional hazards model to estimate overall hazard ratios (HRs) in black versus white men age 18 to 64 and ≥ 65 years, separately.
Receipt of treatment was remarkably similar between blacks and whites in both age groups. Black and white older men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively). Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR, 1.76; 95% CI, 1.11 to 2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR, 1.37; 95% CI, 0.83 to 2.24). In those age ≥ 65 years, the excess risk of death in blacks versus whites was nonsignificant and not affected by adjustment for covariates.
The excess risk of death in black versus white men diagnosed with early-stage breast cancer was largely confined to those age 18 to 64 years and became nonsignificant after adjustment for differences in insurance and income. These findings suggest the importance of improving access to care in reducing racial disparities in male breast cancer mortality.
探讨 18 至 64 岁和≥65 岁男性早期乳腺癌患者接受治疗和生存的黑/白差异程度。
我们从 2004 年至 2011 年国家癌症数据库中确定了 725 名非西班牙裔黑人（黑人）和 5247 名非西班牙裔白人（白人）男性，这些男性被诊断患有早期乳腺癌。我们使用多变量逻辑回归计算标准化风险比来预测治疗的接受情况，并使用比例风险模型分别估计 18 至 64 岁和≥65 岁黑人与白人男性的总危险比（HR）。
在两个年龄组中，黑人与白人患者接受治疗的情况非常相似。与年轻患者相比（分别为 76.7%和 79.3%），年老的黑人男性和白人男性接受化疗的比例较低（分别为 39.2%和 42.0%）。仅调整临床因素后，年轻黑人男性的死亡风险比年轻白人男性高 76%（HR，1.76；95%CI，1.11 至 2.78），但随后调整保险和收入因素后，这种差异显著缩小（HR，1.37；95%CI，0.83 至 2.24）。在≥65 岁的患者中，黑人与白人相比死亡的超额风险无统计学意义，且不受调整协变量的影响。
黑人与白人男性早期乳腺癌患者的死亡超额风险主要局限于 18 至 64 岁年龄组，在调整保险和收入差异后变得无统计学意义。这些发现表明，改善获得医疗保健的机会对于减少男性乳腺癌死亡率的种族差异非常重要。
