Race/ethnic differences in breast cancer survival

PURPOSE: In this study, we investigate the prognostic significance of tumor characteristics, genetic alterations, medical care, psychosocial, and health /medical factors in survival in a cohort of African American and White women diagnosed with breast cancer in the mid to late 1980s. METHODS: Population-based follow-up (mean of 9.2 yrs) study of 145 African American (AA) and White (W) women diagnosed with breast cancer between January, 1987 and May, 1989 in 22 hospitals in Connecticut. RESULTS: African American women were twice as likely to be diagnosed with tumors that were TNM stage II or higher (age-adjusted Odds Ratio [OR] = 2.01, 95% Confidence Interval [CI] 1.24–3.24). Results from Cox Proportional Hazard (CPH) multivariate models demonstrated that TNM stage was the most significant predictor of death due to all causes (Hazard Ratio [HR} 2.83, 95% CI 1.74–4.6). Other factors that were associated (p < .10) with survival in models adjusted for tumor stage and other tumor characteristics included older age, severe obesity at time of diagnosis, low income, and some psychosocial factors (e.g., avoidance of topic, no religious affiliation). In models adjusted for TNM stage, tumor characteristics (e.g., hormone status), menopausal status, socioeconomic status, access to care, insurance coverage, comorbidity, smoking, treatment, and psychosocial factors, race/ethnicity no longer remained a significant predictor of all cause mortality. CONCLUSIONS: Observed race/ethnic disparities in breast cancer survival can be parsed out when considering the full range of possible predictors. Identification of key predictors of survival is an essential first step in lessening the cancer burden in African American women.