Disparities and survival among breast cancer patients.
BACKGROUND
Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased.


OBJECTIVE
To determine whether this survival disparity persists in an insured population with access to medical care.


METHODS
In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, through December 31, 1998. Cox proportional hazards regression was used to estimate the death rate among African American women relative to that of white women after adjustment for potential explanatory factors including stage at diagnosis, tumor characteristics, and treatment.


RESULTS
Five-year survival was lower for African American women (73.8%) than for white women (81.6%). African American women were less likely to have tumor characteristics with good prognosis. Controlling for age at diagnosis, stage, grade, tumor size, and estrogen and progesterone receptor status, the adjusted hazard rate ratio for African American women was 1.34 (95% confidence interval = 1.22 to 1.46). Similar risks were found among women ages 20-49 and 50 and older. Controlling for treatment slightly lowered the hazard rate ratio to 1.31 (95% confidence interval = 1.20 to 1.43).


CONCLUSIONS
Among women with invasive breast cancer, being insured and having access to medical care does not eliminate the survival disparity for African American women.
Field
Terry S
TS
Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation, and Fallon Community Health Plan, 630 Plantation St., Worcester, MA 01605, USA. tfield@meyersprimary.org
Buist
Diana S M
DS
Doubeni
Chyke
C
Enger
Shelley
S
Fouayzi
Hassan
H
Hart
Gene
G
Korner
Eli J
EJ
Lamerato
Lois
L
Bachman
Donald J
DJ
Ellis
Jennifer
J
Herrinton
Lisa
L
Hornbrook
Mark C
MC
Krajenta
Rick
R
Liu
Liyan
L
Yao
Janice
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D001943:Breast Neoplasms / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis*; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone