Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America.
Department of Medicine, University of Washington, Seattle, WA, United States of America.
PLoS One. 2023 Sep 1;18(9):e0291025. doi: 10.1371/journal.pone.0291025. eCollection 2023.
Racial disparities in breast cancer treatment contribute to Black women having the worst breast cancer survival rates in the U.S. We investigated whether differences in receipt of optimal locoregional treatment (OLT), defined as receipt of mastectomy, breast-conserving surgery, or no surgery when contraindicated, existed between Black and White women with early-stage breast cancer from 2008-2018.
In this retrospective cohort study, data from the Surveillance, Epidemiology, and End Results (SEER) Program Incidence Database was utilized to identify tumor cases from Black and White women aged 20-64 years old with stage I-II breast cancer. Logistic regression analyses were used to evaluate the associations between race and receipt of OLT as well as potential effect modification by tumor characteristics, and year of diagnosis.
Among 177,234 women diagnosed with early-stage breast tumors, disparities in OLT between Black and White women were present from 2008-2010 (2008: 82.1% Black vs. 85.7% White, p<0.001; 2009: 82.1% Black vs. 85.8% White, p<0.001; 2010: 82.2% Black vs. 87.2% White, p<0.001). This disparity was eliminated between 2010-2011 (86.3% Black vs. 87.5% White, p = 0.15), and did not reoccur during the remainder of the study period. From 2010-2011, more Black women received radiation therapy following breast-conserving surgery (43.4% to 48.9%; p = 0.001), which accounted for an overall increased receipt of OLT.
Increased receipt of radiation therapy with breast-conserving surgery appeared to drive a substantial increase in OLT for Black women from 2010-2011 that lasted throughout the study period. Further research on the underlying mechanisms that reduced this disparity is warranted.
乳腺癌治疗中的种族差异导致美国黑人女性的乳腺癌生存率最差。我们调查了 2008 年至 2018 年间，早期乳腺癌的黑人和白人女性之间是否存在接受最佳局部区域治疗（OLT）的差异，OLT 定义为接受乳房切除术、保乳手术或在有禁忌症时不进行手术。
在这项回顾性队列研究中，利用监测、流行病学和最终结果（SEER）计划发病率数据库的数据，确定了年龄在 20-64 岁之间、患有 I 期至 II 期乳腺癌的黑人和白人女性的肿瘤病例。使用逻辑回归分析评估种族与接受 OLT 之间的关联，以及肿瘤特征和诊断年份的潜在效应修饰。
在 177234 名被诊断患有早期乳腺癌肿瘤的女性中，2008 年至 2010 年期间，黑人和白人女性之间的 OLT 存在差异（2008 年：82.1%的黑人 vs. 85.7%的白人，p<0.001；2009 年：82.1%的黑人 vs. 85.8%的白人，p<0.001；2010 年：82.2%的黑人 vs. 87.2%的白人，p<0.001）。这一差异在 2010 年至 2011 年期间消除（86.3%的黑人 vs. 87.5%的白人，p = 0.15），并且在研究期间的其余时间没有再次出现。自 2010 年至 2011 年以来，接受保乳手术后接受放射治疗的黑人女性人数有所增加（43.4%至 48.9%；p = 0.001），这导致 OLT 的总体接受率增加。
保乳手术后放射治疗的增加似乎推动了黑人女性从 2010 年至 2011 年 OLT 的大幅增加，这种情况一直持续到研究结束。需要进一步研究减少这一差距的潜在机制。
