Department of Environmental Medicine and Public Health, Mount Sinai Hospital, New York, NY, USA.
Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA.
Cancer Med. 2020 Nov;9(21):8226-8234. doi: 10.1002/cam4.3309. Epub 2020 Oct 2.
Racial disparities in New York City (NYC) breast cancer incidence and mortality rates have previously been demonstrated. Disease stage at diagnosis and mortality-to-incidence ratio (MIR) may present better measures of differences in screening and treatment access. Racial/ethnic trends in NYC MIR have not previously been assessed.
Mammogram rates were compared using the NYC Community Health Survey, 2002-2014. Breast cancer diagnosis, stage, and mortality were from the New York State Cancer Registry, 2000-2016. Primary outcomes were MIR, the ratio of age-adjusted mortality to incidence rates, and stage at diagnosis. Joinpoint regression analysis identified significant trends.
Mammogram rates in 2002-2014 among Black and Latina women ages 40 and older (79.9% and 78.4%, respectively) were stable and higher than among White (73.6%) and Asian/Pacific-Islander women (70.4%) (P < .0001). There were 82 733 incident cases of breast cancer and 16 225 deaths in 2000-2016. White women had the highest incidence, however, rates among Black, Latina, and Asian/Pacific Islander women significantly increased. Black and Latina women presented with local disease (Stage I) less frequently (53.2%, 57.6%, respectively) than White (62.5%) and Asian/Pacific-Islander women (63.0%). Black women presented with distant disease (Stage IV) more frequently than all other groups (Black 8.7%, Latina 5.8%, White 6.0%, and Asian 4.2%). Black women had the highest breast cancer mortality rate and MIR (Black 0.25, Latina 0.18, White 0.17, and Asian women 0.11).
More advanced disease at diagnosis coupled with a slower decrease in breast cancer mortality among Black and Latina women may partially explain persistent disparities in MIR especially prominent among Black women. Assessment of racial/ethnic differences in screening quality and access to high-quality treatment may help identify areas for targeted interventions to improve equity in breast cancer outcomes.
此前已证明，纽约市（NYC）乳腺癌发病率和死亡率存在种族差异。诊断时的疾病分期和死亡率与发病率比（MIR）可能是评估筛查和治疗机会差异的更好指标。以前没有评估过 NYC MIR 的种族/民族趋势。
使用 2002-2014 年纽约市社区健康调查比较了乳房 X 光检查率。2000-2016 年从纽约州癌症登记处获得乳腺癌诊断、分期和死亡率数据。主要结局指标是 MIR，即年龄调整死亡率与发病率的比率，以及诊断时的分期。Joinpoint 回归分析确定了显著的趋势。
2002-2014 年，40 岁及以上的黑人和拉丁裔女性（分别为 79.9%和 78.4%）的乳房 X 光检查率稳定且高于白人（73.6%）和亚裔/太平洋岛民女性（70.4%）（P<.0001）。2000-2016 年期间有 82733 例乳腺癌新发病例和 16225 例死亡。白人女性的发病率最高，但黑种人、拉丁裔和亚裔/太平洋岛民女性的发病率显著增加。黑人女性和拉丁裔女性较少出现局部疾病（I 期）（分别为 53.2%和 57.6%），而白人女性和亚裔/太平洋岛民女性（分别为 62.5%和 63.0%）更多。黑人女性更常出现远处疾病（IV 期）（黑人 8.7%，拉丁裔 5.8%，白人 6.0%，亚洲裔 4.2%）。黑人女性的乳腺癌死亡率和 MIR 最高（黑人 0.25，拉丁裔 0.18，白人 0.17，亚洲女性 0.11）。
诊断时更晚期的疾病，加上黑人女性和拉丁裔女性的乳腺癌死亡率下降速度较慢，可能部分解释了 MIR 持续存在的差异，尤其是在黑人女性中更为明显。评估种族/民族在筛查质量和获得高质量治疗方面的差异，可能有助于确定针对特定领域的干预措施，以改善乳腺癌结局的公平性。
