Comorbidity and Survival Disparities Among Black and White Patients With Breast Cancer

Tammemägi, M.; Nerenz, David R.; Neslund‐Dudas, Christine; Feldkamp, Carolyn S.; Nathanson, David

doi:10.1001/jama.294.14.1765

Cited by 379 publications

(266 citation statements)

References 42 publications

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“…Despite these gains, race/ethnic disparities still persist in cancer incidence, mortality, stage-at-diagnosis, and survival. [1][2][3][4][5][6][7][8] Black women have lower incidence rate but higher mortality rate than non-Hispanic white (hereafter referred as "white") women for all cancer sites combined 2,8 . In addition, black women compared with white women are more likely to have poorer stage distribution (i.e., regional or distant) when diagnosed with cancer and to have lower 5-year survival rates (risk adjusted for age and stage of diagnosis) for most cancer sites 1,9 .…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer Epidemiology in Blacks and Whites: Disparities in Incidence, Mortality, Survival Rates and Histology

Baquet

Mishra

Commiskey

et al. 2008

Journal of the National Medical Association

166

155

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Section: Introductionmentioning

confidence: 99%

Breast Cancer Epidemiology in Blacks and Whites: Disparities in Incidence, Mortality, Survival Rates and Histology

Baquet

Mishra

Commiskey

et al. 2008

Journal of the National Medical Association

166

155

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“…Several factors might account for the stage-specific disparity in survival between Black and White women, including differences in distribution of comorbid conditions or other competing risks (9), differences in biologic characteristics of the tumor (3, 7), differences in treatment received (10,11), lack of access to care (12) or inadequate follow-up after abnormal screening mammography or treatment (13,14), and overall differences in income and insurance coverage (15). Given that there are significant differences by age in the prevalence of comorbid conditions, in insurance coverage, in access to care, and in mammography screening recommendations (16), and that survival after breast cancer diagnosis is dependent on these factors as well as stage at diagnosis, a better understanding of the role of race, age, and stage in breast cancer survival is needed.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage

Deshpande¹,

Jeffe²,

Gnerlich³

et al. 2009

Journal of Surgical Research

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Background-Black women often present with advanced-stage breast cancer compared with White women, which may result in the observed higher mortality among Black women. Agerelated factors (e.g., comorbidity) also affect mortality. Whether racial disparities in mortality are evident within age and/or stage groups has not been reported, and risk factors for greater mortality among Black women are not well defined.

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“…Studies in breast cancer have shown that age, race, and comorbid disease are associated with noncancer mortality. 7,8,[13][14][15] However, these studies analyzed cancer death, rather than recurrence, as a competing risk for noncancer mortality (ie, competing as a first event). This approach is not ideal, because patients with recurrent disease may die of noncancer causes, yet still benefit from additional cancer treatment.…”

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confidence: 99%

Predictors of competing mortality in early breast cancer

Mell

Jeong

Nichols

et al. 2010

Cancer

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BACKGROUND: Death in the absence of disease recurrence (competing mortality) is an important determinant of disease-free survival (DFS) in early breast cancer. The authors sought to identify predictors of this event using competing risks modeling. METHODS: A cohort study was made of 1231 consecutive women with stage I to II invasive breast cancer diagnosed between 1986 and 2004, treated with breast conservation therapy. Median follow-up was 82 months. The authors used a parametric competing risks regression model to analyze factors associated with the cumulative incidence of competing mortality. They generated a risk score from the model coefficient estimates and stratified patients according to low and high risk score for analysis. RESULTS: Ten-year DFS was 69.7% (95% confidence interval [CI], 66.2%-72.9%). The 10-year cumulative incidence of locoregional recurrence (LRR) was 4.4% (95% CI, 3.0%-5.8%), distant recurrence was 7.1% (95% CI, 5.4%-8.9%), and competing mortality was 18.7% (95% CI, 15.9%-21.6%). On multivariate analysis, competing mortality was associated with increasing age (hazard ratio [HR], 1.83 per 10 years; 95% CI, 1.58-2.12), black race (HR, 1.71; 95% CI, 1.17-2.51), and comorbid disease (HR, 1.93, 95% CI, 1.40-2.65). Ten-year cumulative incidences of competing mortality, locoregional recurrence, and distant recurrence for patients at low (n ¼ 638) versus high (n ¼ 593) risk of competing mortality were 7.2% versus 30.6% (P < .001), 4.4% versus 4.4% (P ¼ .97), and 8.6% versus 5.6% (P ¼ .12), respectively. CONCLUSIONS: Competing mortality is an important event influencing 10-year DFS in early breast cancer and is associated with increasing age, black race, and comorbid disease. Stratifying patients according to competing mortality risk may be useful in designing clinical trials. Cancer 2010;116:5365-73.

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Comorbidity and Survival Disparities Among Black and White Patients With Breast Cancer

Cited by 379 publications

References 42 publications

Breast Cancer Epidemiology in Blacks and Whites: Disparities in Incidence, Mortality, Survival Rates and Histology

Breast Cancer Epidemiology in Blacks and Whites: Disparities in Incidence, Mortality, Survival Rates and Histology

Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage

Predictors of competing mortality in early breast cancer

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