title: Racial differences in breast cancer survival: the interaction of socioeconomic status and tumor biology.
abstract: OBJECTIVE
  Our purpose was to evaluate the effect of sociodemographic and clinical variables on survival rates of African-American and white women with breast cancer.
  
  
  METHODS
  Between 1988 and 1992 the Metropolitan Detroit Cancer Surveillance System Identified 10,502 women (82% white and 18% African-American) in whom invasive breast cancer was diagnosed. Cox proportional hazards regression was used to estimate the relative risk of death for African-Americans compared with whites after controlling for variables believed to influence survival.
  
  
  RESULTS
  African-American women were more likely than white women to have tumors that were of a more advanced stage, a higher grade, and hormone receptor-negative. After controlling for age, tumor size, stage, histologic grade, census-derived socioeconomic status, and the presence of a residency training program at the treatment hospital, the relative risk of dying for African-Americans compared with whites was 1.68 (95% confidence interval, 1.27-2.23) for women less than 50 years of age, and 1.33 (95% confidence interval, 1.13-1.56) for women older than 50 years of age.
  
  
  CONCLUSIONS
  Known factors that predict survival differences between African-Americans and whites are more prevalent among women less than 50 years of age, emphasizing the need to focus more attention on public health efforts directed toward younger women.
authors.affiliation: Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Simon
authors.forename: R K
authors.initials: RK
authors.lastname: Severson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People / Q000235:genetics*; D001940:Breast / Q000737:chemistry / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000401:mortality*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D011634:Public Health; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012307:Risk Factors; D012923:Social Class; D015996:Survival Rate; D014504:Urban Health; D044465:White People / Q000235:genetics*; D001741:Black or African American
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone