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Poorer treatment and lower socioeconomic status may underlie ethnic disparities in breast cancer survival

Disparities in early-stage breast cancer survival among elderly black and white women disappear after accounting for black women's lower socioeconomic status and poorer treatment, according to a new study. Xianglin L. Du, M.D., Ph.D., and colleagues at the University of Texas Health Science Center examined clinical and sociodemographic characteristics of 35,029 elderly Medicare-insured women with early-stage breast cancer, whose outcomes they tracked for up to 11 years.

Black women with breast cancer were more likely than their white counterparts to live in the poorest census tract quartiles (73.7 vs. 20.7 percent). More black women also received breast-conserving surgery (BCS) without radiation therapy (15.7 percent) compared with white (12.4 percent), Hispanic (11 percent), and Asian (7.9 percent) women, and women of other ethnicities (14.6 percent). Since the recommended therapy for early-stage breast cancer is BCS plus radiation, these treatment differences could have affected disparities in survival, suggest the researchers.

The 3-year survival from all causes was 86 percent in whites, 78.6 percent in blacks, and 88.4 percent in others. After adjusting for treatment and socioeconomic status, the risk of all-cause mortality was no longer significant in blacks, whereas the risk of breast cancer-specific mortality was marginally higher (by 21 percent, but with wide confidence intervals, ranging from 1 to 46 percent). For example, after adjusting for primary therapy (mastectomy, BCS plus radiation, or BCS without radiation), risk of dying from any cause was reduced in blacks by 7 percent compared with whites and risk of dying from breast cancer was reduced by 25 percent—risks that remained unchanged after adding adjuvant chemotherapy. After additionally controlling for socioeconomic status, the risk of black women dying from any cause was reduced by 2 percent and from breast cancer by 21 percent.

The study was supported in part by the Agency for Healthcare Research and Quality (HS16743).

See "Impact of treatment and socioeconomic status on racial disparities in survival among older women with breast cancer," by Dr. Du, Shenying Fang, M.D., M.S., and Tamra E. Meyer, M.P.H., in the April 2008 American Journal of Clinical Oncology 31(2), pp. 125-132.

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