按雌激素受体和孕激素受体状态分析，乳腺癌诊断后生存的种族/民族差异：一项汇总分析。
Racial/Ethnic Disparities in Survival after Breast Cancer Diagnosis by Estrogen and Progesterone Receptor Status: A Pooled Analysis.
机构信息
Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California.
Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.
出版信息
Cancer Epidemiol Biomarkers Prev. 2021 Feb;30(2):351-363. doi: 10.1158/1055-9965.EPI-20-1291. Epub 2020 Dec 18.
BACKGROUND
Limited studies have investigated racial/ethnic survival disparities for breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR) status in a multiethnic population.
METHODS
Using multivariable Cox proportional hazards models, we assessed associations of race/ethnicity with ER/PR-specific breast cancer mortality in 10,366 California women diagnosed with breast cancer from 1993 to 2009. We evaluated joint associations of race/ethnicity, health care, sociodemographic, and lifestyle factors with mortality.
RESULTS
Among women with ER/PR breast cancer, breast cancer-specific mortality was similar among Hispanic and Asian American women, but higher among African American women [HR, 1.31; 95% confidence interval (CI), 1.05-1.63] compared with non-Hispanic White (NHW) women. Breast cancer-specific mortality was modified by surgery type, hospital type, education, neighborhood socioeconomic status (SES), smoking history, and alcohol consumption. Among African American women, breast cancer-specific mortality was higher among those treated at nonaccredited hospitals (HR, 1.57; 95% CI, 1.21-2.04) and those from lower SES neighborhoods (HR, 1.48; 95% CI, 1.16-1.88) compared with NHW women without these characteristics. Breast cancer-specific mortality was higher among African American women with at least some college education (HR, 1.42; 95% CI, 1.11-1.82) compared with NHW women with similar education. For ER/PR disease, breast cancer-specific mortality did not differ by race/ethnicity and associations of race/ethnicity with breast cancer-specific mortality varied only by neighborhood SES among African American women.
CONCLUSIONS
Racial/ethnic survival disparities are more striking for ER/PR than ER/PR breast cancer. Social determinants and lifestyle factors may explain some of the survival disparities for ER/PR breast cancer.
IMPACT
Addressing these factors may help reduce the higher mortality of African American women with ER/PR breast cancer.
背景
在多民族人群中，针对雌激素受体 (ER) 和孕激素受体 (PR) 状态定义的乳腺癌，仅有少数研究调查了种族/民族的生存差异。
方法
使用多变量 Cox 比例风险模型，我们评估了种族/民族与 1993 年至 2009 年期间在加利福尼亚州诊断出患有乳腺癌的 10366 名女性的 ER/PR 特异性乳腺癌死亡率之间的关联。我们评估了种族/民族、医疗保健、社会人口统计学和生活方式因素与死亡率的联合关联。
结果
在患有 ER/PR 乳腺癌的女性中，西班牙裔和亚裔美国女性的乳腺癌特异性死亡率相似，但非洲裔美国女性的死亡率高于非西班牙裔白人（HR，1.31；95%置信区间 [CI]，1.05-1.63）。乳腺癌特异性死亡率受手术类型、医院类型、教育程度、社区社会经济地位 (SES)、吸烟史和饮酒史的影响。在非洲裔美国女性中，在未获得认证的医院接受治疗的女性（HR，1.57；95%CI，1.21-2.04）和来自 SES 较低社区的女性（HR，1.48；95%CI，1.16-1.88）的乳腺癌特异性死亡率高于具有这些特征的非西班牙裔白人女性。与具有相似教育背景的非西班牙裔白人女性相比，至少接受过一些大学教育的非洲裔美国女性的乳腺癌特异性死亡率更高（HR，1.42；95%CI，1.11-1.82）。对于 ER/PR 疾病，种族/民族与乳腺癌特异性死亡率之间没有差异，并且只有在非洲裔美国女性中，种族/民族与乳腺癌特异性死亡率之间的关联仅受社区 SES 的影响。
结论
与 ER/PR 乳腺癌相比，ER/PR 乳腺癌的种族/民族生存差异更为明显。社会决定因素和生活方式因素可能解释了 ER/PR 乳腺癌部分生存差异的原因。
影响
解决这些因素可能有助于降低 ER/PR 乳腺癌非洲裔美国女性的死亡率。
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