Viewpoint: Explaining Racial Disparities in Survival Rates of Breast Cancer Patients

Nancy U. Lin, MD


May 01, 2006

Meta-Analysis of Survival in African American and White American Patients With Breast Cancer: Ethnicity Compared With Socioeconomic Status

Newman LA, Griffith KA, Jatoi I, Simon MS, Crowe JP, Colditz GA
J Clin Oncol. 2006;24:1342-1349

This study represents a pooled analysis of 20 studies that provided data regarding survival and socioeconomic status (SES) and included 14,013 African-American and 76,111 white-American patients with breast cancer who were diagnosed between 1961 and 2003. The pooled estimate for all-cause mortality, after adjustment for SES, was 1.28 (95% confidence interval [CI], 1.18-1.38), with African-American patients experiencing increased mortality compared with white-American patients. Breast cancer mortality was also significantly higher in African Americans, even after adjustment for age, stage, and SES (hazard ratio 1.19, 95% CI, 1.10-1.29).

Increased all-cause and breast-cancer-specific mortality in African Americans, compared with white Americans, has been observed in many studies examining the relationship between ethnicity and outcome in breast cancer patients. This study further refines the estimate of the relative disparity, which persisted despite adjustment for SES, suggesting that not all of the difference can be explained by unequal access to care. The study did have several limitations, particularly in the ascertainment of SES, which was assigned using census block or census tract information.

The authors hypothesized that biological variation in the spectrum of breast cancer that arises in different ethnic groups may account for some of the disparity. For example, several groups have described a higher-than-expected incidence of basal-like tumors in African-American women.[2,3] Data from cooperative group clinical trials have been conflicting, with the majority of studies demonstrating equal outcomes with equal care, and several studies suggesting differences in outcomes according to ethnicity despite adherence to protocol-based therapy.[4,5]

From a public health perspective, there is ample reason to continue to improve on efforts to improve access to care, and on optimizing the care of patients within the healthcare system.[6] Data from the current study underscore the additional importance of exploring differences in tumor biology that may allow for further improvement in the care of African-American women with breast cancer.



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