Hunter C P, Redmond C K, Chen V W, Austin D F, Greenberg R S, Correa P, Muss H B, Forman M R, Wesley M N, Blacklow R S
Office of Research on Women's Health, National Institutes of Health, Bethesda, Md 20892.
J Natl Cancer Inst. 1993 Jul 21;85(14):1129-37. doi: 10.1093/jnci/85.14.1129.
Numerous studies have reported differences in cancer staging at diagnosis and in survival between Black and White patients with breast cancer. Utilizing data obtained from the National Cancer Institute's (NCI's) Black/White Cancer Survival Study for the period 1985-1986, a new study is presented here that systematically examines multiple explanatory factors (e.g., lack of mammograms) associated with these cancer-staging differences.
We evaluated within a single study the relationship of selected demographic, lifestyle, antecedent medical experiences, and health care access factors to cancer staging at diagnosis in Black and White breast cancer patients.
Data utilized in this population-based cohort study of 1222 eligible women (649 Black and 573 White) newly diagnosed for the period 1985-1986 with histologically confirmed primary breast cancer were obtained from the NCI's Black/White Cancer Survival Study. Sources of data included abstracts of hospital medical records, central review of histology slides by a study consultant pathologist, and patient interviews obtained from three metropolitan areas: Atlanta, New Orleans, and San Francisco-Oakland. Within each area, 70% of all Black incident cases were randomly selected, and a sample of White cases, frequency matched by age groups (20-49 years, 50-64 years, and 65-79 years), was selected for comparison. Stage of breast cancer at diagnosis was classified according to the international tumor-lymph node-metastases (TNM) system. Statistical models utilized in this study included the log-linear and polychotomous logistic regression with multiple predictor variables.
Factors associated with cancer staging were differentially expressed in Blacks and Whites. Indicators of access to health care, a lack of mammograms, and an increased body mass index significantly (P < .02) contributed to stage differences in Blacks, whereas income was marginally associated (P = .06) with stage for Whites only. Nuclear grade, having a breast examination by a physician, and a history of patient delay explained approximately 50% of the excess risk for stage III-IV cancer versus stage I-IIN0 cancer among Blacks compared with Whites (odds ratio reduction from 2.19 to 1.68).
These findings suggest that no single factor or group of factors can explain more than half of the race-stage differences noted in this study with respect to Black and White breast cancer patients.
众多研究报告了乳腺癌患者中，黑人和白人在诊断时的癌症分期及生存率存在差异。利用从美国国立癌症研究所（NCI）的1985 - 1986年黑/白癌症生存研究中获取的数据，本文呈现了一项新研究，该研究系统地考察了与这些癌症分期差异相关的多个解释性因素（如缺乏乳房X光检查）。
我们在一项单一研究中评估了选定的人口统计学、生活方式、既往医疗经历和医疗保健可及性因素与黑人和白人乳腺癌患者诊断时癌症分期的关系。
本基于人群的队列研究纳入了1222名符合条件的女性（649名黑人女性和573名白人女性），她们于1985 - 1986年新诊断为组织学确诊的原发性乳腺癌，数据来自NCI的黑/白癌症生存研究。数据来源包括医院病历摘要、研究顾问病理学家对组织学切片的集中审查以及从三个大都市地区（亚特兰大、新奥尔良和旧金山 - 奥克兰）获取的患者访谈。在每个地区，随机选取所有黑人新发病例的70%，并选取按年龄组（20 - 49岁、50 - 64岁和65 - 79岁）频率匹配的白人病例样本进行比较。诊断时的乳腺癌分期根据国际肿瘤 - 淋巴结 - 转移（TNM）系统进行分类。本研究中使用的统计模型包括具有多个预测变量的对数线性模型和多分类逻辑回归模型。
与癌症分期相关的因素在黑人和白人中存在差异表达。医疗保健可及性指标、缺乏乳房X光检查以及体重指数增加对黑人的分期差异有显著贡献（P <.02），而收入仅与白人的分期有边缘关联（P =.06）。核分级、由医生进行乳房检查以及患者延误病史解释了黑人与白人相比，III - IV期癌症相对于I - IIN0期癌症额外风险的约50%（优势比从2.19降至1.68）。
这些发现表明，在本研究中，没有单一因素或一组因素能够解释黑人和白人乳腺癌患者种族 - 分期差异的一半以上。
