Comparison of Breast Cancer Treatment Regimens by Demographic Characteristics

摘要

The purpose of this study was to measure ethnic differences in treatment and survival between African American (AA) and European American (EA) women with breast cancer. We abstracted data on cases of breast cancer diagnosed in members of an HMO in metropolitan Detroit between 1986-1996 (N=886) and followed these cases for survival through April 1997 (N=137 deaths). AA women were diagnosed at a later stage when compared with EA women. Five-year survival was 77% for AAs and 84% for EAs. The crude hazard for AAs relative to EAs was 1. 6 (95% confidence interval (CI) 1.1, 2.2). Adjusting only for stage of disc at diagnosis, the hazard ratio was 1.3 (95% CI 0.9, 1.9). Adjusting only for sociodemographics (age, marital status an income), the hazard ratio was 1.2 (95% CI 0.8, 1.9). After adjusting for sociodemographics and stage, the hazard ratio 1.0 (95% CI 0.7, 1.5). We found no material racial differences in the surgical management of breast cancer. Among women with similar medical care access, we found ethnic differences in stage of breast cancer at diagnosis. Adjusting this difference and for income, age and marital status, eliminates the effect of race on survival. The methods used in this study as well as the cohort of women that was assembled for this study has also lead additional analyses contributing to the development of hypotheses that will be investigated in future studies. Preliminary results of one analysis examining ethnicity, stage of detection and mammography use show that among women age 40-49 AA ethnicity was strongly associated with later stage at diagnosis, even after adjustment for screening mammography (adjusted odds ratio= 2.8, 95% CI 1.2-6.8). These results indicate that factors other than mammography use may explain late stage at diagnosis in the subgroup of younger (age 40-49) African American women.