Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
Division of Internal Medicine, Maimonides Medical Center, 4802 10th Avenue, New York, NY, 11219, USA.
Breast Cancer Res Treat. 2019 Jul;176(2):461-467. doi: 10.1007/s10549-019-05250-8. Epub 2019 Apr 26.
Despite lower incidence rates among black women and a national decline in breast cancer (BC) deaths, there is a widening gap in BC mortality rates between black and white women in the United States. A previous study evaluating data from 1992 to 1999 found a racial disparity in the receipt of surveillance mammography. We sought to evaluate whether this disparity persists between black and white women diagnosed with BC between 2000 and 2011.
Using the SEER-Medicare registry, we conducted an analysis of women ≥ 66 years diagnosed with early-stage (0-III) BC between 2000 and 2011 who underwent BC surgery. The primary outcome was receipt of surveillance mammography within 12 months of surgery. Chi square analyses were used to compare characteristics between black and white women. Multivariate logistic regression was used to assess receipt of surveillance mammography after controlling for potential confounders.
There were 3353 black and 40,564 white women in the final cohort. After adjusting for confounders, black women were still 24% less likely than white women to receive surveillance mammography (Odds ratio 0.76, 95% CI 0.70-0.0.82). Those who were married, younger, in the highest income quartile, diagnosed at earlier stages, had a lower comorbidity score, or who resided in metropolitan areas were more likely to receive surveillance mammography (p < 0.05).
CONCLUSION(S): We found that older black BC survivors continue to experience lower rates of surveillance mammography, even after adjusting for multiple potential confounders. There remains a need to investigate which individual and systemic factors affect disparities in breast cancer care.
尽管黑人女性的发病率较低，且美国全国范围内乳腺癌（BC）死亡率下降，但美国黑人女性和白人女性之间的 BC 死亡率差距仍在扩大。此前一项评估 1992 年至 1999 年数据的研究发现，在接受监测性乳房 X 光检查方面存在种族差异。我们试图评估 2000 年至 2011 年间诊断出患有 BC 的黑人和白人女性之间是否仍然存在这种差异。
我们使用 SEER-Medicare 登记处，对 2000 年至 2011 年间接受 BC 手术的年龄≥66 岁、诊断为早期（0-III 期）BC 的女性进行了分析。主要结果是在手术后 12 个月内接受监测性乳房 X 光检查。使用卡方分析比较了黑人和白人女性之间的特征。使用多变量逻辑回归在控制潜在混杂因素后评估监测性乳房 X 光检查的接受情况。
最终队列中有 3353 名黑人女性和 40564 名白人女性。在调整混杂因素后，黑人女性接受监测性乳房 X 光检查的可能性仍比白人女性低 24%（比值比 0.76，95%置信区间 0.70-0.0.82）。那些已婚、年龄较小、收入最高四分位数、诊断较早、合并症评分较低或居住在大都市区的女性更有可能接受监测性乳房 X 光检查（p<0.05）。
我们发现，即使在调整了多个潜在混杂因素后，年龄较大的黑人 BC 幸存者接受监测性乳房 X 光检查的比例仍然较低。仍需要研究哪些个体和系统因素会影响乳腺癌护理方面的差异。
