Disparities in survival after female breast cancer diagnosis

A population-based study

Stacey L. Tannenbaum, Tulay Sengul, Feng Miao, Margaret M Byrne

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Despite advances in treatment and increased screening, female breast cancer survival is affected by race, ethnicity, and socioeconomic status (SES). The purpose of this study was to substantiate disparities in breast cancer mortality in a large and unique dataset containing 7 distinct racial groups, 31 comorbidities, demographic and clinical/pathological patient characteristics, and neighborhood poverty information. Methods: Florida Cancer Data System registry (1996-2007) linked with the Agency for Health Care Administration and U.S. Census tract (n = 127,754) explored median survival and 1-, 3-, and 5-year survival rates by the Kaplan-Meier method. Log-rank tests compared survival curves by race/ethnicity/SES. Cox proportional hazards regression models were used to obtain unadjusted and adjusted hazard ratios (HR) and 95 % confidence intervals. Results: Native Americans had the lowest median survival (7.4 years) and Asians had the highest (12.6 years). For the univariate analysis, worse survival was seen for blacks (HR = 1.44; p < 0.001) and better survival for Asians (HR = 0.71; p < 0.001), Asian Indians or Pakistanis (HR = 0.65; p = 0.013), and Hispanics (HR = 0.92; p < 0.001). Multivariate analysis demonstrated sustained survival detriment for blacks (HR = 1.28; p < 0.001) and improved survival for Hispanics (HR = 0.90; p = 0.001). For SES, there was an incremental improvement in survival for each higher SES category in all analyses (p < 0.001). Conclusions: Utilizing a large enriched state cancer registry controlling for multiple demographic, clinical, and comorbidities, we fully explored survival disparities in female breast cancer and found certain aspects of race, ethnicity, and SES to remain significantly associated with breast cancer survival. More research is needed to uncover the source of these ongoing disparities.

Original languageEnglish
Pages (from-to)1705-1715
Number of pages11
JournalCancer Causes and Control
Volume24
Issue number9
DOIs
StatePublished - Sep 1 2013

Fingerprint

Breast Neoplasms
Survival
Social Class
Population
Hispanic Americans
Registries
Comorbidity
Demography
North American Indians
Censuses
Poverty
Proportional Hazards Models
Information Systems
Neoplasms
Multivariate Analysis
Survival Rate
Confidence Intervals
Delivery of Health Care
Mortality
Research

Keywords

  • Breast cancer
  • Ethnicity
  • Health care disparities
  • Patient outcomes assessment
  • Socioeconomic status
  • Survival analysis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Disparities in survival after female breast cancer diagnosis : A population-based study. / Tannenbaum, Stacey L.; Sengul, Tulay; Miao, Feng; Byrne, Margaret M.

In: Cancer Causes and Control, Vol. 24, No. 9, 01.09.2013, p. 1705-1715.

Research output: Contribution to journalArticle

Tannenbaum, Stacey L. ; Sengul, Tulay ; Miao, Feng ; Byrne, Margaret M. / Disparities in survival after female breast cancer diagnosis : A population-based study. In: Cancer Causes and Control. 2013 ; Vol. 24, No. 9. pp. 1705-1715.
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AB - Background: Despite advances in treatment and increased screening, female breast cancer survival is affected by race, ethnicity, and socioeconomic status (SES). The purpose of this study was to substantiate disparities in breast cancer mortality in a large and unique dataset containing 7 distinct racial groups, 31 comorbidities, demographic and clinical/pathological patient characteristics, and neighborhood poverty information. Methods: Florida Cancer Data System registry (1996-2007) linked with the Agency for Health Care Administration and U.S. Census tract (n = 127,754) explored median survival and 1-, 3-, and 5-year survival rates by the Kaplan-Meier method. Log-rank tests compared survival curves by race/ethnicity/SES. Cox proportional hazards regression models were used to obtain unadjusted and adjusted hazard ratios (HR) and 95 % confidence intervals. Results: Native Americans had the lowest median survival (7.4 years) and Asians had the highest (12.6 years). For the univariate analysis, worse survival was seen for blacks (HR = 1.44; p < 0.001) and better survival for Asians (HR = 0.71; p < 0.001), Asian Indians or Pakistanis (HR = 0.65; p = 0.013), and Hispanics (HR = 0.92; p < 0.001). Multivariate analysis demonstrated sustained survival detriment for blacks (HR = 1.28; p < 0.001) and improved survival for Hispanics (HR = 0.90; p = 0.001). For SES, there was an incremental improvement in survival for each higher SES category in all analyses (p < 0.001). Conclusions: Utilizing a large enriched state cancer registry controlling for multiple demographic, clinical, and comorbidities, we fully explored survival disparities in female breast cancer and found certain aspects of race, ethnicity, and SES to remain significantly associated with breast cancer survival. More research is needed to uncover the source of these ongoing disparities.

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KW - Patient outcomes assessment

KW - Socioeconomic status

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