title: Race as a social construct in head and neck cancer outcomes.
abstract: OBJECTIVE
  The authors examined ancestry informative markers (AIMs) to estimate the amount of population admixture and control for this heterogeneity for stage and survival in a primary head and neck squamous cell carcinoma (HNSCC) cohort.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Integrated health care system.
  
  
  METHODS
  The cohort comprised 358 patients with HNSCC who self-reported race as Caucasian American (CA), African American (AA), or other.
  
  
  METHODS
  DNA was interrogated for West African (WA) and European genetic background by genotyping AIMs. Associations of race (self-report or WA ancestry) with stage and survival were analyzed using logistic regression and Cox regression modeling. A subgroup analysis for diagnosis (late vs early stage) and survival (time to death) and WA ancestry was performed for self-reported AAs.
  
  
  RESULTS
  There were significant associations between stage and self-reported race (P = .04 [univariate]) and with cancer site (oropharynx: P = .014; hypopharynx: P = .026 [multivariate]). For prognosis, there were significant multivariate associations between stage (P = .002), age (>65 years, P < .001), and cancer site (hypopharynx: P < .001; oral cavity: P = .049), but self-reported race was not associated with overall survival. Interestingly, there was no association with degree of WA ancestry and stage or survival. In the subgroup analysis of genetic ancestry among self-reported AAs, cancer site remained an independent risk factor for stage (other site: P = .026) and survival (oropharynx: P = .036). Late stage persisted as an independent variable for poor survival (P = .032).
  
  
  CONCLUSIONS
  Stratification within AAs by WA ancestry revealed no correlation with stage or survival, suggesting that HNSCC outcomes with race may be owing to social/behavior factors rather than biological differences.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Henry Ford Health System, Detroit, MI 48202, USA. mworsha1@hfhs.org
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Worsham
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.forename: Rick A
authors.initials: RA
authors.lastname: Kittles
mesh_terms: D001741:Black or African American; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D055106:Genome-Wide Association Study; D006258:Head and Neck Neoplasms / Q000208:ethnology* / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000208:ethnology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000208:ethnology / Q000601:surgery; D020641:Polymorphism, Single Nucleotide; D011379:Prognosis; D044465:White People