Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer Epidemiol Biomarkers Prev. 2022 Jun 1;31(6):1185-1194. doi: 10.1158/1055-9965.EPI-22-0020.
Prior studies of breast cancer disparities have focused primarily on differences between Black and White women, yet contemporary patterns of disparity for other groups are not well understood. We examine breast cancer disparities by stage at diagnosis across nine racial and ethnic groups.
The SEER 18 registries identified 841,975 women diagnosed with breast cancer from 2000 to 2017. Joinpoint models assessed trends in diagnosis stage and survival. Multivariable logistic regression evaluated associations between race/ethnicity and diagnosis stage. Multivariable Cox models compared survival of groups by stage and molecular subtype.
Black, American Indian, Southeast Asian, South Asian, Pacific Islander, and Hispanic women were less likely than white women to be diagnosed with early stage breast cancer. Among those diagnosed at early stage, Hispanic, American Indian, Pacific Islander and Black women were 9%, 14%, 22%, and 39% (respectively) more likely than White women to die from breast cancer, whereas Asian subgroups had lower risk of death. Among those diagnosed at late stage, Black women were 18% more likely than White counterparts to die from breast cancer, and survival disparities for Black women persisted across all subtypes and stages, (except late stage HR-/HER2-). East Asian women with early stage HR+/HER2- tumors had better survival than White women.
Persistent disparities in early detection and survival of breast cancer demand further work to address and reduce disparities across the cancer continuum.
Results have implications for efforts to reduce entrenched racial and ethnic disparities in breast cancer early detection and survival.
先前关于乳腺癌差异的研究主要集中在黑人和白人女性之间的差异上，但其他群体的当代差异模式尚未得到很好的理解。我们研究了九个种族和族裔群体在诊断时的乳腺癌差异。
SEER 18 登记处确定了 841975 名 2000 年至 2017 年期间被诊断患有乳腺癌的女性。Joinpoint 模型评估了诊断阶段和生存趋势。多变量逻辑回归评估了种族/族裔与诊断阶段之间的关联。多变量 Cox 模型比较了不同阶段和分子亚型的群体的生存情况。
黑人、美洲印第安人、东南亚人、南亚人、太平洋岛民和西班牙裔女性比白人女性更不可能被诊断为早期乳腺癌。在那些被诊断为早期乳腺癌的患者中，西班牙裔、美洲印第安人、太平洋岛民和黑人女性死于乳腺癌的风险比白人女性分别高 9%、14%、22%和 39%（分别），而亚洲亚组的死亡风险较低。在那些被诊断为晚期的患者中，黑人女性死于乳腺癌的风险比白人女性高 18%，并且黑人女性的生存差异在所有亚型和阶段都存在，（除了晚期 HR-/HER2-）。早期 HR+/HER2-肿瘤的东亚女性的生存情况优于白人女性。
乳腺癌早期检测和生存方面持续存在的差异需要进一步努力，以解决和减少整个癌症过程中的差异。
研究结果对减少乳腺癌早期检测和生存方面根深蒂固的种族和族裔差异的努力具有重要意义。
