Black-White Differences in Breast Cancer Outcomes Among Older Medicare Beneficiaries

Mandelblatt, Jeanne S.; Sheppard, Vanessa B.; Neugut, Alfred I.

doi:10.1001/jama.2013.8273

Cited by 17 publications

(8 citation statements)

References 14 publications

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“…This observation was associated with poorer prognostic factors (such as HR-negative disease, obesity), and a higher incidence of toxicity compared with white patients [20]. Prior to the 1980s, there were almost no racial differences in metastatic breast cancer mortality but there were also very few available treatments [41]. As highly costly and possibly indefinite treatments such as trastuzumab and other new therapies become available, vulnerable populations will have a persistently higher risk of not receiving adequate therapy.…”

Section: Discussionmentioning

confidence: 99%

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype

Vaz-Luís

Lin

Keating

et al. 2015

Breast Cancer Res Treat

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Treatment advances have differed by breast cancer subtype. We examined the impact of race on survival of women with metastatic breast cancer by disease subgroup. Using surveillance, epidemiology, and end results -Medicare data, we included white and black patients aged ≥66 with de novo metastatic breast cancer diagnosed between 1998 and 2009. Using trastuzumab as a proxy for human epidermal growth factor receptor 2 (HER2)-positive status, we defined three disease subgroups: (1) HER2-positive (received trastuzumab), (2) HER2-negative/unknown (never received trastuzumab)/hormone receptor (HR)-positive, and (3) HER2-negative/unknown/HR-negative. Multivariate Cox proportional models assessed the impact of race on overall survival (OS) and breast cancer-specific survival by subgroup. We also examined trastuzumab treatment patterns. Among 4364 women (86 % white, 14 % black), 9 % had HER2-positive, 72 % had HER2-negative/unknown/HR-positive, and 18 % had HER2-negative/unknown/HR-negative tumors. Patients with HER2-positive disease experienced longer median OS compared with others: 2.4 versus 1.8 years for women with HER2-negative/unknown/HR-positive and 0.5 years for women with HER2-negative/unknown/HR-negative disease (P < 0.001). Racial differences in OS were only observed among patients with HER2-positive tumors: median OS: 1.4 versus 2.7 years for black and white women, adjusted hazard ratio 1.45; 95 % Confidence interval 1.01-2.08. Results for breast cancer-specific survival were similar. We also observed racial differences in trastuzumab utilization, with longer median time to trastuzumab initiation and lower likelihood of continuation over time for black (vs. white) patients. Among women with de novo metastatic breast cancer, racial differences in survival were only apparent for those with inferred HER2-positive tumors. Further study of how treatment patterns affect outcomes is warranted.

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Section: Discussionmentioning

confidence: 99%

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype

Vaz-Luís

Lin

Keating

et al. 2015

Breast Cancer Res Treat

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“…A potential explanation is disparate access to high-quality treatment for Black women ( 47 ). Additionally, Black women are more likely to have longer delay from diagnosis until treatment ( 55 ), are less likely to complete treatment appropriate for the tumor characteristics ( 56 ), and are more likely to refuse treatment ( 57 ), compared to White women.…”

Section: Female Breast Cancermentioning

confidence: 99%

Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010

O'Keefe

Meltzer

Bethea

2015

Front. Public Health

192

148

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Declining cancer incidence and mortality rates in the United States (U.S.) have continued through the first decade of the twenty-first century. Reductions in tobacco use, greater uptake of prevention measures, adoption of early detection methods, and improved treatments have resulted in improved outcomes for both men and women. However, Black Americans continue to have the higher cancer mortality rates and shorter survival times. This review discusses and compares the cancer mortality rates and mortality trends for Blacks and Whites. The complex relationship between socioeconomic status and race and its contribution to racial cancer disparities is discussed. Based on current trends and the potential and limitations of the patient protection and affordable care act with its mandate to reduce health care inequities, future trends, and challenges in cancer mortality disparities in the U.S. are explored.

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“…Disparities impact African American women across the breast cancer spectrum with respect to access and utilization of screening and preventive services, clinical care subsequent to breast cancer diagnosis, and long-term follow-up care and clinical management for Black breast cancer survivors [1] . Racial differences in breast cancer survival can be explained by poorer health of Black patients at diagnosis, more advanced disease at time of diagnosis, more severe biological features of the disease, and more co-morbid conditions [2] , [3] . The data collected by Silber et al.…”

Section: Introductionmentioning

confidence: 99%

Focus on You: Cancer clinical trials perspectives

Robinson

Newman

Wallington

et al. 2016

Contemporary Clinical Trials Communications

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BackgroundClinical trials test new ways to prevent, detect, diagnose, or treat diseases. Researchers have found that minority patients are willing to participate in clinical trials, yet these patients have barriers which hinder their access to trials.MethodsTo explore African American women's participation in breast cancer clinical trials, eight focus groups were conducted with breast cancer patients, family members/care givers, religious leaders, and healthcare providers to gather information on the perspectives and opinions on the topic. The focus group conversations were transcribed, and transcripts were imported into QSR International's NVivo 10 software. The transcripts were organized into folders based on four categories. The content analysis performed was based on recordings and notes.ResultsThe following themes were generated as a result of conducting these focus groups and gathering information on the perspectives and opinions about participating in clinical trials, based on the groups who participated: Promoting participation in research; Personal experience with cancer; Support and support services; Awareness, knowledge, and experience with clinical trials; Providers' roles in clinical trials.ConclusionThe data collected in this study present several actionable themes that, if addressed by individual researchers and the medical community at large, could increase participation in clinical trials by African American patients. They also provide a deeper and more nuanced understanding of the factors influencing African American patients' decisions around participating in clinical trials.

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Black-White Differences in Breast Cancer Outcomes Among Older Medicare Beneficiaries

Cited by 17 publications

References 14 publications

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype

Racial differences in outcomes for patients with metastatic breast cancer by disease subtype

Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010

Focus on You: Cancer clinical trials perspectives

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