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Breast cancer survival poorer in black women
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Five-year breast cancer survival rates were more than 12% lower in black women than in white women, according to results of a recent analysis.
Jeffrey H. Silber, MD, PhD, of Children’s Hospital of Philadelphia, and colleagues compared data for 7,375 black women aged 65 years and older with three sets of 7,375 matched white women in a control group. The investigators used SEER data to select controls from 99,898 potential participants.
Eligible black women had been diagnosed with breast cancer between 1991 and 2005. Follow-up continued through Dec. 31, 2009.
Five-year survival served as the primary outcome measure.
The 5-year survival rate was 55.9% among black women and 68.8% among white women, for an absolute difference of 12.9% (95% CI, 11.5%-14.5%). This difference remained consistent throughout the study duration.
When patients were matched for presentation characteristics, researchers observed an absolute difference in 5-year survival of 4.4% (95% CI, 2.8%-5.8%). Black women also had a 3.6% (95% CI, 2.3%-4.9%) lower survival rate than white women when the cohorts were matched on treatment.
In the presentation analysis, 87.4% of black women received treatment compared with 91.8% of white women (P<.001). Black women had a longer duration from diagnosis to treatment (29.2 days vs. 22.8 days; P<.001) and were less likely to receive anthracyclines and taxols (3.7% vs. 5%; P<.001). The rate of breast conservation surgery without other therapy was 8.2% in black women and 7.3% in white women (P=.04).
However, the researchers noted that just 0.81% of the 12.9% survival difference was associated with treatment differences.
Researchers reported considerable differences in the way black and white patients presented. For example, black patients showed significantly less evidence of at least one primary care visit than white patients (80.5% vs. 88.5%) and reported significantly lower rates of breast cancer screening (23.5% vs. 35.7%).
“Our results suggest that it may be difficult to eliminate the racial disparity in survival from diagnosis unless differences in presentation can be reduced,” Silber and colleagues wrote. “The disparity in treatment might matter more if the disparity in presentation were reduced, because blacks would then be diagnosed with less advanced disease, for which treatment is more effective.”
In an accompanying editorial, Jeanne S. Mandelblatt, MD, MPH, of the cancer prevention and control program at Georgetown Lombardi Comprehensive Cancer Center, and colleagues suggested the authors’ conclusions that treatment is associated with a small fraction of the racial differences in survival can be questioned for many reasons, some of which relate to limitations of the SEER data.
Certain specific information was lacking, including data on chemotherapy dosage and hormone therapy, disease stage, and why delays in treatment initiation occurred.
However, the editorialists suggested that “targeting standard-of-care treatment for women with breast cancer most likely to benefit by virtue of stage and tumor markers is a balanced public health approach for the increasing population of older woman and may be the most efficient means of reducing black-white differences in the Medicare-aged population.”
The variety of opinions on the value of treatment demonstrates that the role of race in cancer outcomes is complex, Mandelblatt and colleagues wrote.
“Differing perspectives on the value of treatment illustrate the complexity of understanding racial disparities in cancer outcomes,” they wrote. “This is underscored in the secondary analysis by Silber et al showing that after matching on dual eligibility for Medicare and Medicaid, the hazard ratio for black vs. white differences in mortality was no longer significant. This result suggests that it is not black and white differences but rather socioeconomic status that most likely is a key driver of disparities in cancer outcomes, even among women with access to health care via the Medicare program.”
Mandelblatt and colleagues concluded that the study was rigorous, and that it “provides additional clues to the black-white differences in breast cancer outcomes. Ultimately, for any cancer control strategy to succeed, improved care quality appears to be a necessary, but not sufficient, condition to eliminate race-based mortality differences in the United States.”
Disclosure: The researchers report no relevant financial disclosures.