title: Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for Black women after breast cancer treatment.
abstract: BACKGROUND
  Black women appear to have worse outcome after diagnosis and treatment of breast cancer. It is still unclear if this is because Black race is more often associated with known negative prognostic indicators or if it is an independent prognostic factor. To study this, we analyzed a patient cohort from an urban university medical center where these women made up the majority of the patient population.
  
  
  METHODS
  We used retrospective analysis of a prospectively collected database of breast cancer patients seen from May 1999 to June 2006. Time to recurrence and survival were analyzed using the Kaplan-Meier method, with statistical analysis by chi-square, log rank testing, and the Cox regression model.
  
  
  RESULTS
  265 female patients were diagnosed with breast cancer during the time period. Fifty patients (19%) had pure DCIS and 215 patients (81%) had invasive disease. Racial and ethnic composition of the entire cohort was as follows: Black (N = 150, 56.6%), Hispanic (N = 83, 31.3%), Caucasian (N = 26, 9.8%), Asian (N = 4, 1.5%), and Arabic (N = 2, 0.8%). For patients with invasive disease, independent predictors of poor disease-free survival included tumor size, node-positivity, incompletion of adjuvant therapy, and Black race. Tumor size, node-positivity, and Black race were independently associated with disease-specific overall survival.
  
  
  CONCLUSIONS
  Worse outcome among Black women appears to be independent of the usual predictors of survival. Further investigation is necessary to identify the cause of this survival disparity. Barriers to completion of standard post-operative treatment regimens may be especially important in this regard.
authors.affiliation: Department of Surgery, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA, 18711, USA. shkim1@geisinger.edu
authors.forename: Steve H
authors.initials: SH
authors.lastname: Kim
authors.forename: Jeanne
authors.initials: J
authors.lastname: Ferrante
authors.forename: Bok Ran
authors.initials: BR
authors.lastname: Won
authors.forename: Meera
authors.initials: M
authors.lastname: Hameed
mesh_terms: D001741:Black or African American; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010349:Patient Compliance; D011182:Postoperative Care; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States