Are there racial differences in breast cancer treatments and clinical outcomes for women treated at M.D. Anderson Cancer Center?
OBJECTIVE
To determine the influence of race on breast cancer treatment and on recurrence and breast cancer specific death.


METHODS
The study population consisted of 6,054 African-American or white women who were diagnosed with breast cancer and received at least one of the treatments including mastectomy or breast conservative surgery, radiation, adjuvant chemotherapy, neo-adjuvant chemotherapy, and adjuvant endocrine therapy at M.D. Anderson Cancer Center between June 1997 and February 2005. The clinical outcomes were disease-free survival and breast-cancer-specific survival. Logistic regression analysis was performed to investigate if race was associated with the selection of each primary treatment while adjusting for tumor characteristics at diagnosis. Cox proportional hazards model was used to determine the effect of race on recurrence-free survival and breast-cancer-specific survival controlling for tumor characteristics, presence of co-morbidity conditions and use of these treatments.


RESULTS
The use of any primary treatment for breast cancer was not significantly different by race after adjusting for tumor characteristics and co-morbidity conditions. Although tumor characteristics at diagnosis explained the major differences in clinical outcomes, race remained an independent prognostic factor for breast-cancer-specific survival (P=0.002), and a marginally significant factor for disease-free survival (P=0.063) in multivariate analyses.


CONCLUSIONS
Equal treatment may not lead to equal clinical outcomes given similar tumor characteristics at diagnosis. To reduce racial differences in breast cancer recurrence and survival, it is important to have a better understanding of differences in tumor biology by race and to promote the use of early detection programs among African-American women.
Shen
Yu
Y
Department of Biostatistics and Applied Mathematics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 447, Houston, TX 77030, USA. yshen@mdanderson.org
Dong
Wenli
W
Esteva
Francisco J
FJ
Kau
Shu-Wan
SW
Theriault
Richard L
RL
Bevers
Therese B
TB
D001741:Black or African American / Q000208:ethnology*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D011878:Radiotherapy; D016896:Treatment Outcome
D000970:Antineoplastic Agents