Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
Department of Medicine, Albert Einstein College of Medicine; Montefiore Medical Center, Bronx, NY, 10461, USA.
J Racial Ethn Health Disparities. 2017 Dec;4(6):1181-1188. doi: 10.1007/s40615-016-0324-y. Epub 2016 Dec 21.
Compared to non-Hispanic whites, African-American women tend to be diagnosed with breast cancer at an earlier age, to have less favorable tumor characteristics, and to have poorer outcomes from breast cancer. The extent to which differences in clinical characteristics account for the black/white disparity in breast cancer mortality is unclear. The purpose of this investigation was to examine the association of clinical, demographic, and treatment variables with total mortality and breast cancer recurrence by race/ethnicity in a cohort of women diagnosed with invasive breast cancer.
To this end, we used data on 3890 invasive breast cancer cases diagnosed at a single medical center. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association of tumor characteristics and treatment variables with mortality and recurrence.
Compared to white women, black women with breast cancer presented with tumors that had worse prognostic factors, particularly higher stage, lower frequency of hormone-receptor positive tumors, and higher frequency of comorbidities. Hispanics also generally had less favorable prognostic factors compared to non-Hispanic whites. Among estrogen receptor-positive cases, blacks had roughly a two-fold increased risk of recurrence compared to non-Hispanic whites. However, ethnicity/race was not associated with total mortality. Tumor stage, tumor size, and Charlson comorbidity index were positively associated with mortality, and mammography and chemotherapy and hormone therapy were inversely associated with mortality.
In spite of poorer prognostic factors among blacks compared whites, race/ethnicity was not associated with total mortality in our study.
与非西班牙裔白人相比，非裔美国女性往往在更年轻时被诊断出患有乳腺癌，肿瘤特征不太有利，并且乳腺癌的预后较差。临床特征的差异在多大程度上导致了乳腺癌死亡率的黑/白差异尚不清楚。本研究的目的是检查种族/民族之间的临床、人口统计学和治疗变量与浸润性乳腺癌女性队列的总死亡率和乳腺癌复发之间的关联。
为此，我们使用了单家医疗中心诊断的 3890 例浸润性乳腺癌病例的数据。使用 Cox 比例风险模型估计肿瘤特征和治疗变量与死亡率和复发的关联的风险比 (HR) 和 95%置信区间 (95%CI)。
与白人女性相比，患有乳腺癌的黑人女性的肿瘤具有更差的预后因素，特别是更高的分期、激素受体阳性肿瘤的频率较低以及合并症的频率较高。与非西班牙裔白人相比，西班牙裔通常也具有较差的预后因素。在雌激素受体阳性病例中，黑人的复发风险比非西班牙裔白人高约两倍。然而，种族/民族与总死亡率无关。肿瘤分期、肿瘤大小和 Charlson 合并症指数与死亡率呈正相关，而乳房 X 线摄影术、化学疗法和激素疗法与死亡率呈负相关。
尽管与白人相比，黑人的预后因素较差，但在我们的研究中，种族/民族与总死亡率无关。
