Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program at Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
Departments of Family and Social Medicine and of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
J Natl Cancer Inst Monogr. 2023 Nov 8;2023(62):178-187. doi: 10.1093/jncimonographs/lgad023.
Populations of African American or Black women have persistently higher breast cancer mortality than the overall US population, despite having slightly lower age-adjusted incidence.
Three Cancer Intervention and Surveillance Modeling Network simulation teams modeled cancer mortality disparities between Black female populations and the overall US population. Model inputs used racial group-specific data from clinical trials, national registries, nationally representative surveys, and observational studies. Analyses began with cancer mortality in the overall population and sequentially replaced parameters for Black populations to quantify the percentage of modeled breast cancer morality disparities attributable to differences in demographics, incidence, access to screening and treatment, and variation in tumor biology and response to therapy.
Results were similar across the 3 models. In 2019, racial differences in incidence and competing mortality accounted for a net ‒1% of mortality disparities, while tumor subtype and stage distributions accounted for a mean of 20% (range across models = 13%-24%), and screening accounted for a mean of 3% (range = 3%-4%) of the modeled mortality disparities. Treatment parameters accounted for the majority of modeled mortality disparities: mean = 17% (range = 16%-19%) for treatment initiation and mean = 61% (range = 57%-63%) for real-world effectiveness.
Our model results suggest that changes in policies that target improvements in treatment access could increase breast cancer equity. The findings also highlight that efforts must extend beyond policies targeting equity in treatment initiation to include high-quality treatment completion. This research will facilitate future modeling to test the effects of different specific policy changes on mortality disparities.
非裔美国或黑人女性群体的乳腺癌死亡率持续高于全美总体水平，尽管其年龄调整发病率略低。
三个癌症干预和监测建模网络模拟团队对黑人女性群体与全美总体人群之间的癌症死亡率差异进行了建模。模型输入使用了来自临床试验、国家登记处、全国代表性调查和观察性研究的种族群体特异性数据。分析从总体人群的癌症死亡率开始，然后依次用黑人人群的参数替换，以量化归因于人口统计学差异、发病率差异、筛查和治疗机会差异以及肿瘤生物学和对治疗反应差异的建模乳腺癌死亡率差异的百分比。
三个模型的结果相似。2019 年，发病率和竞争死亡率方面的种族差异导致死亡率差异净减少 1%，而肿瘤亚型和分期分布平均占 20%（模型间范围为 13%-24%），筛查平均占 3%（范围为 3%-4%）。治疗参数占建模死亡率差异的大部分：治疗开始的平均比例为 17%（范围为 16%-19%），真实世界疗效的平均比例为 61%（范围为 57%-63%）。
我们的模型结果表明，针对改善治疗机会的政策变化可能会增加乳腺癌公平性。研究结果还强调，必须努力扩大政策范围，不仅要针对治疗开始的公平性，还要包括高质量的治疗完成。这项研究将有助于未来进行模型测试，以检验不同具体政策变化对死亡率差异的影响。
