Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35.
BACKGROUND
The age specific breast cancer incidence rate for African-American women under age 35 is more than twice the rate for white women of similar age, and the mortality rate is more than three times higher. To determine factors that may explain racial/ethnic variation in outcomes among young women diagnosed with breast cancer, the authors examined the clinical presentation, treatment, and survival of African-American, Hispanic, and white women under age 35 years.


METHODS
Surveillance, Epidemiology, and End Results (SEER) Program data for 1990-1998 and SEER Patterns of Care data for 1990, 1991, and 1995 were used for this analysis. Multivariate logistic regression analyses were performed to examine factors associated with the receipt of selected breast cancer treatments. Kaplan-Meier survival analyses and Cox proportional hazards regression analyses were used to examine 5-year overall survival and disease-specific survival.


RESULTS
The authors found racial/ethnic variation in clinical presentation, treatment, and survival. Both African-American and Hispanic women presented with higher disease stage and a higher prevalence of adverse prognostic indicators compared to white women. African-American and Hispanic women received cancer-directed surgery and radiation less frequently after undergoing breast-conserving surgery. Racial/ethnic differences in clinical presentation and treatment were associated with poorer overall survival in unadjusted analyses. African-American and Hispanic women also had poorer overall survival after controlling for clinical and demographic characteristics and type of treatment.


CONCLUSIONS
Future research studies should further examine the factors that influence racial/ethnic differences in incidence, clinical presentation, and treatment differentials among young women diagnosed with breast cancer. A better understanding of these factors will facilitate the development of strategies to help eliminate this health disparity.
Shavers
Vickie L
VL
Applied Research Program, Health Service and Economics Branch, Division of Cancer Control and Population Science, National Cancer Institute, 6130 Executive Boulevard, MSC 7344, EPN Room 4005, Bethesda, MD 20892-7344, USA. shaversv@mail.nih.gov
Harlan
Linda C
LC
Stevens
Jennifer L
JL
D000293:Adolescent; D000328:Adult; D044383:Black People; D001943:Breast Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000628:therapy; D003710:Demography; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American