Caplan L S, Helzlsouer K J, Shapiro S, Freedman L S, Coates R J, Edwards B K
Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, USA.
Am J Epidemiol. 1995 Oct 15;142(8):804-12. doi: 10.1093/oxfordjournals.aje.a117719.
Survival differences have been noted between black women and white women with breast cancer. It is hypothesized that a prolonged interval between initial medical consultation and establishment of a diagnosis (system delay), resulting in a more advanced stage of disease at diagnosis, might explain part of this survival difference. This study was performed to determine whether system delay differs between black and white breast cancer patients, and to examine predictors of delay in blacks and whites. The study population consisted of 996 female breast cancer patients from the National Cancer Institute's Black/White Cancer Survival Study, a cohort study carried out in 1985-1986 in the metropolitan areas of Atlanta, Georgia, New Orleans, Louisiana, and San Francisco/Oakland, California. The median system delay was slightly longer for blacks than for whites--2.7 weeks versus 2.1 weeks--but this difference was not statistically significant. Having a palpable lump at diagnosis was associated with reduced system delay in both races, while use of a public clinic increased system delay for blacks. Older women were less likely to be subject to longer system delay than younger women, and this effect was somewhat more pronounced in whites. Survival differences between blacks and whites are probably not due to differences in system delay. However, many women had delays of at least 3 months. Given that younger age and the absence of a palpable lump were the factors most predictive of significant system delay, interventions should be targeted specifically toward reducing system delay in younger women who present without the classical painless lump.
已注意到患有乳腺癌的黑人女性和白人女性在生存率上存在差异。据推测，从首次就医咨询到确诊之间的间隔时间延长（系统延误），导致确诊时疾病处于更晚期阶段，这可能是造成这种生存率差异的部分原因。本研究旨在确定黑人与白人乳腺癌患者的系统延误是否存在差异，并研究黑人和白人延误的预测因素。研究人群包括来自美国国立癌症研究所黑/白癌症生存研究的996名女性乳腺癌患者，该队列研究于1985 - 1986年在佐治亚州亚特兰大、路易斯安那州新奥尔良以及加利福尼亚州旧金山/奥克兰的大都市地区开展。黑人的中位系统延误略长于白人，分别为2.7周和2.1周，但这种差异无统计学意义。确诊时可触及肿块与两个种族的系统延误减少相关，而黑人使用公共诊所会增加系统延误。老年女性比年轻女性更不容易出现较长的系统延误，这种影响在白人中更为明显。黑人和白人之间的生存率差异可能并非由于系统延误的差异。然而，许多女性的延误至少达3个月。鉴于年轻和无明显可触及肿块是显著系统延误的最具预测性的因素，干预措施应专门针对减少那些没有典型无痛肿块的年轻女性的系统延误。
