Disaggregating the effects of race on breast cancer survival.
OBJECTIVE
This study examines differences in breast cancer survival between African-American and white women to determine whether there is a racial difference in survival after accounting for established influences on outcome, such as stage of cancer, health status, health behavior, utilization patterns, access to care, quality of care, and the doctor-patient relationship.


METHODS
This study is a retrospective review of clinical records. The sample consists of 246 patients of three staff model HMOs who had mastectomies at stage II or above. Data on patient demographics, stage of cancer, health status, and health behavior and utilization, including preventive care, were extracted from patient records. Multivariate logistic regression was used to predict the determinants of advanced stage of cancer. Cox survival analysis was used to predict the determinants of survival.


RESULTS
Missed appointments and stage of cancer were the key determinants of survival. The effect of race on survival was marginal after adjusting for these factors. Race, patients who missed appointments, and patients who delayed in reporting breast cancer symptoms were determinants of advanced stage. African-Americans were overrepresented among patients who missed appointments.


CONCLUSIONS
Missed appointments was a determinant of both advanced stage and shorter survival. This measure is an important component of how race affects survival. Compliance with appointment keeping and alleviating reasons for noncompliance must be considered as factors in breast cancer survival.
Howard
D L
DL
University of North Carolina at Chapel Hill, USA. dhoward@mail.schsr.unc.edu
Penchansky
R
R
Brown
M B
MB
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000359:Aftercare / Q000706:statistics & numerical data; D000368:Aged; D000704:Analysis of Variance; D044383:Black People; D001943:Breast Neoplasms / Q000208:ethnology* / Q000235:genetics / Q000401:mortality* / Q000601:surgery; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States; D044465:White People / Q000706:statistics & numerical data