Racial disparities in treatment and survival of women with stage I–III breast cancer at a large academic medical center in metropolitan Detroit

Abstract

African-American (AA) women with breast cancer have higher mortality rates than Caucasian woman, and some studies have suggested that this disparity may be partly explained by unequal access to medical care. The purpose of this study was to analyze racial differences in patterns and costs of care and survival among women treated for invasive breast cancer at a large academic medical center. Subjects included 331 AA and 257 Caucasian women diagnosed with stage I-III breast cancer between 1994 and 1997. Clinical, socio-demographic, and cost data were obtained from the medical record, cancer registry, and hospital financial database. Data were collected on the use of cancer directed treatments (surgery, radiation, chemo and hormonal therapy) up to 1-year post-diagnosis. Survival analyses compared disease-free and overall survival by race adjusting for age, stage, nodal involvement, ER/PR status and a diagnosis of hypertension, diabetes, heart disease and cerebral vascular accident. There were no significant racial differences in treatment utilization and costs. The mean total 1-year treatment costs were US 16,348 dollars for AAs and US 15,120 dollars for Caucasians. While AAs had a significantly higher unadjusted relative risk (RR) of recurrence 2.09 (95% CI: 1.41-3.10) and death 1.56 (95% CI: 1.09-2.25), the multivariate adjusted analyses resulted in no significant differences in recurrence 1.38 (95% CI: 0.85-2.26) or death 1.06 (95% CI: 0.64-1.75). There was no obvious racial disparity in treatment and costs noted. Our findings support the theory that equal treatments produce equal outcomes. Improvement in screening may have an important impact on survival among minority women with breast cancer.

Diabetes Mellitus and Breast Cancer Outcomes: A Systematic Review and Meta-Analysis

“…16 To assess the impact of study quality, we conducted a sensitivity analysis that omitted lower quality studies. We considered studies to be of higher quality and calculated separate random-effects pooled HRs if they were population based (n ϭ 4) 6,17-19 or used medical records or medication use for diabetes ascertainment (n ϭ 4) 17,18,20,21 and evaluated diabetes as the primary exposure variable (n ϭ 3).…”

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

“…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.…”

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

“…[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. 5,8,9,[12][13][14] Differences in mammography utilization are widely believed to contribute to observed socioeconomic and racial/ethnic variation in prevalence of late-stage diagnosis.…”