Parity and disparity in first course treatment of invasive breast cancer

Lund, Mary Jo; Brawley, Otis; Ward, Kevin C.; Young, John L.; Gabram, Sheryl; Eley, J. William

doi:10.1007/s10549-007-9675-8

Cited by 128 publications

(113 citation statements)

References 52 publications

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“…Because of the limited follow-up period, currently, we cannot appropriately assess this but will continue follow-up. In combination with our knowledge of the treatment among those tested with the RS (and those not tested; data not shown), racial differences in outcome among ER-positive/lymph node-negative patients reported by others, 4,5,11,12,23 thus, may be related to treatment efficacy, eg, endocrine agent metabolism, 24 as well as under treatment, 5-7 treatment compliance, [5][6][7] and differences in established prognostic factors or underlying tumor biology. 4,10 Currently, we are investigating the potential for differences in endocrine agent metabolism.…”

Section: February 1 2012mentioning

confidence: 66%

21‐Gene recurrence scores

Lund

Mošunjac

Davis

et al. 2011

Cancer

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BACKGROUND: African American (AA) women experience higher breast cancer mortality than white (W) women. These differences persist even among estrogen receptor (ER)-positive breast cancers. The 21-gene recurrence score (RS) predicts recurrence in patients with ER-positive/lymph node-negative breast cancer according to RS score-low risk (RS, 0-18), intermediate risk (RS,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), and high risk (RS, >31). The high-risk group is most likely to benefit from chemotherapy, to achieve minimal benefit from hormonal therapy, and to exhibit lower ER levels (intrinsically luminal B cancers). In the current study, the authors investigated racial differences in RS testing, scores, treatment, and outcome. METHODS: Tumor registry data from 3 Atlanta hospitals identified women who were diagnosed with breast ]; P < .0001). Tumors were distributed into the following groups according to risk: low risk (n ¼ 133), medium risk (n ¼ 113), and high risk (n ¼ 26). The mean RS did not differ by race, but risk groups did (low-risk group: 46.1% vs 50% for AA women and W women, respectively; high-risk group: 15.8% vs 7.1%, respectively; P ¼ .043). In multivariate analyses, AA race (odds ratio, 3.6) was associated independently with high risk scores. CONCLUSIONS: AA women were half as likely as W women to receive 21-gene RS testing but were 2-fold more likely to be categorized as high risk. The current data suggested that testing guidelines are not applied equivalently, testing bias may attenuate racial differences in RS, and disparate outcomes may be explained in part by differences in RS, although compliance and pharmacogenomics also may play a role. Cancer 2012;118:788-

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Section: February 1 2012mentioning

confidence: 66%

21‐Gene recurrence scores

Lund

Mošunjac

Davis

et al. 2011

Cancer

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“…34 Several studies have revealed disparities because of race/ethnicity, older age, and geographic location in breast cancer care, including the receipt of RT after BCS. 12,13,27,[35][36][37][38][39][40][41][42][43] The present study, however, is the first to document a disparity in the receipt of RT because of race/ethnicity and SES in a single region within the state of California, and an age disparity throughout the entire state. LA, the most populous of the California regions with the largest number and highest percentage of African American and Hispanic residents in this study, is the only region where the association of RT after BCS varied by race/ethnicity.…”

Section: Discussionmentioning

confidence: 88%

Disparities in receipt of adjuvant radiation therapy after breast‐conserving surgery among the cancer‐reporting regions of California

Parise

Bauer

Caggiano

2011

Cancer

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BACKGROUND: Incidence and mortality of breast cancer vary according to demographic factors such as age, race/ ethnicity, socioeconomic status (SES), and geographic region. This study assesses the variation of these factors in the use of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) among 8 regions of California. METHODS: The authors identified 85,574 cases of first primary female invasive breast cancer with complete data diagnosed between January 1, 2000 and December 31, 2007. Logistic regression was used to determine the association between race/ethnicity, age, SES, and receipt of RT after BCS within each of the regions of California. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. RESULTS: Age was a significant predictor of receipt of RT after BCS in all regions. In Los Angeles (LA), lower SES was associated with decreasing odds of RT. Racial disparities were evident only in LA, where black (OR, 0.85; 95% CI, 0.74-0.97) and Hispanic (OR, 0.86; 95% CI, 0.78-0.96) women were about 15% less likely to receive RT than white women. CONCLUSIONS: Racial disparities in the receipt of RT after BCS exist only in LA, where African American and Hispanic women are less likely to receive this form of adjuvant treatment. Lower SES was also associated with a reduced likelihood of receipt of RT in LA. Women age 70 years and older are less likely to receive RT after BCS in all regions of California.

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“…And this study's hypothesized African American disadvantage among younger women was not only observed for survival, but also for receipt of a number of treatments. This study could also be limited by the known incompletion of its chemo and hormonal therapy data: 8% and 4%, respectively [64]. Again, we think its pattern of findings not to be potently confounded.…”

Section: Study Limitations and Strengthsmentioning

confidence: 84%

Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975–2001

Gorey

Luginaah

Schwartz

et al. 2008

Breast Cancer Res Treat

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Purpose-This study examined whether race/ethnicity had differential effects on breast cancer care and survival across age strata and cohorts within stages of disease. Methods-TheDetroit Cancer Registry provided 25,997 breast cancer cases. African American and non-Hispanic white, older Medicare-eligible and younger non-eligible women were compared. Successive historical cohorts (1975-1980 and 1990-1995) CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptResults-African American disadvantages on survival and treatments increased significantly, particularly among younger women who were much more likely to be uninsured. Within node positive disease all treatment disadvantages among younger African American women disappeared with socioeconomic adjustment.Conclusions-Growth of this racial divide implicates social, rather than biological, forces. Its elimination will require high quality health care for all.

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Parity and disparity in first course treatment of invasive breast cancer

Cited by 128 publications

References 52 publications

21‐Gene recurrence scores

21‐Gene recurrence scores

Disparities in receipt of adjuvant radiation therapy after breast‐conserving surgery among the cancer‐reporting regions of California

Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975–2001

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