title: Has racial difference in cause-specific death improved in older patients with late-stage breast cancer?
abstract: BACKGROUND
  Research on temporal mortality trends for stage IV breast cancer is limited, especially among older patients by race. We evaluated factors associated with overall, breast cancer-specific and other-cause mortalities using contemporary population data.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results-Medicare linked data, we identified older women (≥ 66 years) with stage IV breast cancer diagnosed in 2002-2009. Overall mortality was estimated by the Kaplan-Meier method, compared by log-rank tests, and modeled by Cox models. Competing risk analysis was used to evaluate breast cancer-specific and other-cause mortalities.
  
  
  RESULTS
  The median overall survival time for non-Hispanic blacks improved from 8.6 months in 2002-2003 to 9.9 months in 2007-2009, whereas that for non-Hispanic whites improved from 12.1 to 14.8 months. In the multivariate model, the risk of breast cancer-specific death for patients diagnosed in 2007-2009 was significantly lower (P = 0.02), whereas the risk of other-cause mortality changed little (P = 0.88) compared with those risks for patients diagnosed in 2002-2003. Non-Hispanic blacks had the higher risk of both mortality types compared with non-Hispanic whites; a diagnosis time-race interaction term was not statistically significant for either cause of death.
  
  
  CONCLUSIONS
  Breast cancer-specific mortality among older women modestly improved from 2002 to 2009 across all races, but not other-cause mortality. Racial disparity in mortality persisted, but did not widen in this period. Efforts should be devoted to improving other-cause mortality for all women, with special attention toward decreasing breast cancer mortality for non-Hispanic black women.
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ning
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: S
authors.initials: S
authors.lastname: Peng
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: N
authors.initials: N
authors.lastname: Ueno
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Shih
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: M
authors.initials: M
authors.lastname: Karuturi
authors.affiliation: Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: S
authors.initials: S
authors.lastname: Giordano
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA yshen@mdanderson.org.
authors.forename: Y
authors.initials: Y
authors.lastname: Shen
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data*
keywords: Medicare; SEER program; breast cancer-specific mortality; competing risk; older stage IV breast cancer; other-cause mortality