Effects of race and socioeconomic status on survival of 1,332 black, hispanic, and white women with breast cancer

Franzini, Luisa; Williams, Anna Fay; Franklin, Jack; Singletary, S. Eva; Theriault, Richard L.

doi:10.1007/bf02303792

Cited by 69 publications

(55 citation statements)

References 35 publications

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“…3,[16][17][18][19][20][21] However, only few studies evaluated the reasons of such social disparities. 12,34,35,[41][42][43][44][45][46][47] All these studies have demonstrated that differences in stage at diagnosis or in tumor characteristics only partly explain the SES differences in breast cancer mortality. To our knowledge, the present study is the first to consider, in addition to stage and tumor characteristics, other well established prognostic factors linked to patient characteristics, screening and treatment and their interaction on SES impact on breast cancer mortality.…”

Section: Discussionmentioning

confidence: 99%

Social class is an important and independent prognostic factor of breast cancer mortality

Bouchardy

Verkooijen

Fioretta

2006

Intl Journal of Cancer

121

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Reasons of the important impact of socioeconomic status on breast cancer prognosis are far from established. This study aims to evaluate and explain the social disparities in breast cancer survival in the Swiss canton of Geneva, where healthcare costs and life expectancy are among the highest in the world. This populationbased study included all 3,920 female residents of Geneva, who were diagnosed with invasive breast cancer before the age of 70 years between 1980 and 2000. Patients were divided into 4 socioeconomic groups, according to the woman's last occupation. We used Cox multivariate regression analysis to identify reasons for the socioeconomic inequalities in breast cancer survival. Compared to patients of high social class, those of low social class had an increased risk (unadjusted hazard ratio [HR] 2.4, 95% CI: 1.6-3.5) of dying as a result of breast cancer. These women were more often foreigners, less frequently had screen-detected cancer and were at more advanced stage at diagnosis. They less frequently underwent breast-conserving surgery, hormonal therapy, and chemotherapy, in particular, in case of axillary lymph node involvement. When adjusting for all these factors, patients of low social class still had a significantly increased risk of dying of breast cancer (HR 1.8, 95% CI: 1.2-2.6). Overmortality linked to low SES is only partly explained by delayed diagnosis, unfavorable tumor characteristics and suboptimal treatments. Other factors, not measured in this study, also could play a role. While waiting for the outcome of other researches, we should consider socioeconomic status as an independent prognostic factor and provide intensified support and surveillance to women of low social class. ' 2006 Wiley-Liss, Inc.Key words: breast carcinoma; socioeconomic status; incidence; mortality; survivalIn North America and Western Europe, breast cancer accounts for more than 30% of new cancer cases and for 25% of cancer deaths among women. Breast cancer mortality rates are now decreasing because of the widely generalized use of mammography screening and the improvement in treatment. 1 Besides stage, tumor characteristics and treatment, only few factors are recognized as independent prognostic factors. Socioeconomic status (SES) could be one of them.Breast cancer occurs more frequently in wealthy countries 2 and among women with high SES. 3 This is partly due to a higher prevalence of breast cancer risk factors, such as older age at first pregnancy, low parity, high-calorie intake, sedentary occupation and use of hormonal replacement therapy in women with high SES. [3][4][5] On the other hand, breast cancer survival is in general lower in less affluent countries 6 and in women with low income or educational level. 3

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Section: Discussionmentioning

confidence: 99%

Social class is an important and independent prognostic factor of breast cancer mortality

Bouchardy

Verkooijen

Fioretta

2006

Intl Journal of Cancer

121

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“…[7][8][9][10][11]26,27 This inconsistency may reflect study design issues such as differences in outcome definition (any cause of death vs. death from breast carcinoma), risk factor inclusion, or statistical power. For example, a Michigan study looking at all-cause mortality found no black/white survival difference after adjustment for stage in a managed-care population of breast carcinoma patients, suggesting that health care access eliminated disparity.…”

Section: Survival In Blacksmentioning

confidence: 99%

“…Like black women, Hispanic women also tend to be diagnosed with breast carcinoma at a later stage than white women, but it is unclear if Hispanic females have poorer survival. 9,[12][13][14][15] International studies of breast carcinoma have shown better survival for Japanese than Caucasians, 16 but most studies report similar survival rates for Asians and whites within the United States. 12,[17][18][19] In addition, although race/ethnicity, disease stage, and SES are correlated, SES measures have not been included in most studies of Asian and Hispanic women.…”

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confidence: 99%

Socioeconomic status and breast carcinoma survival in four racial/ethnic groups

O’Malley

Glaser

et al. 2003

Cancer

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Efficient trapping of chromium enolates in the presence of Et3SiCl gives silyl enol ethers. This trapping changes the course of the reaction between α,β‐unsaturated ketones and aldehydes from a sequential aldol–cyclopropanol formation to a cross pinacol‐type coupling reaction [Eq. (1); for example, R1 = n‐C8H17, R2 = Ph(CH2)2]. The anti/syn ratios of the 1,2‐diols depend on the reaction temperature.

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“…Poor women and those who are uninsured have poorer breast cancer survival than their more advantaged counter-parts. [1][2][3][4][5] Compared to non-Hispanic (NH) White women, most U.S. ethnic minority populations have lower breast cancer survival, much of which is attributable to socioeconomic factors. [5][6][7][8][9][10][11] One of the reasons for these disparities in breast cancer outcomes is the well-documented tendency toward later stage at diagnosis among women of lower socioeconomic status (SES) and women of color.…”

Section: Introductionmentioning

confidence: 99%

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

Zenk

Tarlov²,

Sun³

2006

J Urban Health

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Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low-or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African-Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low-or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures-distance and public transportation travel time-is less strong in African-American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African-American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African-American residents. Thus, it appears that the spatial accessibility of low-and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.

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Effects of race and socioeconomic status on survival of 1,332 black, hispanic, and white women with breast cancer

Abstract: These results suggest that institutional factors, such as access to treatment, do not explain survival differences by race or SES. Other factors associated with low SES, such as life-style and behavior, may affect survival.

Cited by 69 publications

References 35 publications

Social class is an important and independent prognostic factor of breast cancer mortality

Social class is an important and independent prognostic factor of breast cancer mortality

Socioeconomic status and breast carcinoma survival in four racial/ethnic groups

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

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