Racial differences in survival of female breast cancer in the Detroit metropolitan area

Cancer. 1996 Jan 15;77(2):308-14. doi: 10.1002/(SICI)1097-0142(19960115)77:2<308::AID-CNCR13>3.0.CO;2-5.

Abstract

Background: In the United States, breast cancer survival is worse among African-American women compared with white women. This difference in survival is likely due to several factors, including tumor biology and/or access to care. In this analysis, we evaluated the effects of sociodemographic and clinical variables on differences in breast cancer survival among African-American and white women.

Methods: The study population included 10,502 women (82% white, 18% African-American), diagnosed between 1988 and 1992 and identified through the Metropolitan Detroit Cancer Surveillance System, a member of the Surveillance, Epidemiology and End-Results (SEER) Program. Cox proportional hazards regression was used to estimate the relative risk of death comparing African-American women with white women after controlling for variables believed to influence survival.

Results: The mean age at diagnosis was 61 years and average length of follow-up was 34 months (range, 1-78 months). African-American women were more likely to present with regional or distant disease (45%) than were white women (37%). Although white women had better survival than African-American women during the first 4 years postdiagnosis (P < 0.0001), there were no significant differences in survival by race for women who lived longer than 4 years (P = 0.64). There was a significant interaction between age and race. The unadjusted relative risk of dying for African-American women compared with white women was 2.35 (95% confidence interval [CI], 1.88-2.93) for women younger than 50 years of age, and was 1.66 (95% CI, 1.46-1.88) for women age 50 years or older. After controlling for age, tumor size, stage, histologic grade, census-derived socioeconomic status, and residency training status, the relative risk was 1.68 (95% CI, 1.27-2.24) for women younger than 50 years of age and 1.33 (95% CI, 1.13-1.56) for women age 50 years and older. Adjustment for marital status, hospital size, and the proportion of Medicaid or Medicare discharges had no further effect on the relative risk.

Conclusions: Known factors that predict survival differences between African-American and white women are more prevalent among women younger than age 50.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Black People*
  • Black or African American
  • Breast Neoplasms / mortality*
  • Breast Neoplasms / pathology
  • Carcinoma / mortality*
  • Carcinoma / pathology
  • Female
  • Health Facility Size
  • Humans
  • Lymphatic Metastasis
  • Medicaid
  • Michigan
  • Middle Aged
  • Multivariate Analysis
  • Registries
  • Survival Analysis
  • United States
  • White People*