University of Central Florida College of Medicine, Orlando, FL, USA.
University of Central Florida College of Medicine, Orlando, FL, USA.
Cancer Epidemiol. 2022 Aug;79:102206. doi: 10.1016/j.canep.2022.102206. Epub 2022 Jun 24.
Racial (Black vs. White) disparities in breast cancer survival have proven difficult to mitigate. Targeted strategies aimed at the primary factors driving the disparity offer the greatest potential for success. The purpose of this study was to use multiple mediation analysis to identify the most important mediators of the racial disparity in breast cancer survival.
This was a retrospective cohort study of non-Hispanic Black and non-Hispanic White women diagnosed with invasive breast cancer in Florida between 2004 and 2015. Cox regression was used to obtain unadjusted and adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association of race with 5- and 10-year breast cancer death. Multiple mediation analysis of tumor (advanced disease stage, tumor grade, hormone receptor status) and treatment-related factors (receipt of surgery, chemotherapy, radiotherapy, and hormone therapy) was used to determine the most important mediators of the survival disparity.
The study population consisted of 101,872 women of whom 87.0% (n = 88,617) were White and 13.0% were Black (n = 13,255). Black women experienced 2.3 times (HR, 2.27; 95% CI, 2.16-2.38) the rate of 5-year breast cancer death over the follow-up period, which decreased to a 38% increased rate (HR, 1.38; 95% CI, 1.31-1.45) after adjustment for age and the mediators of interest. Combined, all examined mediators explained 73% of the racial disparity in 5-year breast cancer survival. The most important mediators were: (1) advanced disease stage (44.8%), (2) nonreceipt of surgery (34.2%), and (3) tumor grade (18.2%) and hormone receptor status (17.6%). Similar results were obtained for 10-year breast cancer death.
These results suggest that additional efforts to increase uptake of screening mammography in hard-to-reach women, and, following diagnosis, access to and receipt of surgery may offer the greatest potential to reduce racial disparities in breast cancer survival for women in Florida.
在乳腺癌生存方面，存在着难以消除的种族差异（黑人和白人）。针对导致这种差异的主要因素制定的靶向策略最有可能取得成功。本研究的目的是使用多重中介分析来确定导致乳腺癌生存种族差异的最重要中介因素。
这是一项回顾性队列研究，纳入了 2004 年至 2015 年间在佛罗里达州被诊断患有浸润性乳腺癌的非西班牙裔黑人及非西班牙裔白人女性。采用 Cox 回归获得种族与 5 年和 10 年乳腺癌死亡相关的未经调整和调整后的危险比（HR）及其 95%置信区间（CI）。采用肿瘤（晚期疾病分期、肿瘤分级、激素受体状态）和治疗相关因素（手术、化疗、放疗和激素治疗的接受情况）的多重中介分析，以确定生存差异的最重要中介因素。
该研究人群由 101872 名女性组成，其中 87.0%（n=88617）为白人，13.0%为黑人（n=13255）。黑人女性在随访期间乳腺癌 5 年死亡的发生率是白人的 2.3 倍（HR，2.27；95%CI，2.16-2.38），但在调整年龄和感兴趣的中介因素后，该比率增加了 38%（HR，1.38；95%CI，1.31-1.45）。所有检查的中介因素联合解释了 5 年乳腺癌生存率种族差异的 73%。最重要的中介因素是：（1）晚期疾病分期（44.8%）、（2）未接受手术（34.2%）、（3）肿瘤分级（18.2%）和激素受体状态（17.6%）。10 年乳腺癌死亡也得到了类似的结果。
这些结果表明，增加难以接触的女性接受筛查性乳房 X 线检查的力度，以及在诊断后增加并接受手术的机会，可能为佛罗里达州女性降低乳腺癌生存的种族差异提供最大的潜力。
