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Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for Black women after breast cancer treatment.

Kim SH, Ferrante J, Won BR, Hameed M - World J Surg Oncol (2008)

Bottom Line: Tumor size, node-positivity, and Black race were independently associated with disease-specific overall survival.Worse outcome among Black women appears to be independent of the usual predictors of survival.Barriers to completion of standard post-operative treatment regimens may be especially important in this regard.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA, 18711, USA. shkim1@geisinger.edu

ABSTRACT

Introduction: Black women appear to have worse outcome after diagnosis and treatment of breast cancer. It is still unclear if this is because Black race is more often associated with known negative prognostic indicators or if it is an independent prognostic factor. To study this, we analyzed a patient cohort from an urban university medical center where these women made up the majority of the patient population.

Methods: We used retrospective analysis of a prospectively collected database of breast cancer patients seen from May 1999 to June 2006. Time to recurrence and survival were analyzed using the Kaplan-Meier method, with statistical analysis by chi-square, log rank testing, and the Cox regression model.

Results: 265 female patients were diagnosed with breast cancer during the time period. Fifty patients (19%) had pure DCIS and 215 patients (81%) had invasive disease. Racial and ethnic composition of the entire cohort was as follows: Black (N = 150, 56.6%), Hispanic (N = 83, 31.3%), Caucasian (N = 26, 9.8%), Asian (N = 4, 1.5%), and Arabic (N = 2, 0.8%). For patients with invasive disease, independent predictors of poor disease-free survival included tumor size, node-positivity, incompletion of adjuvant therapy, and Black race. Tumor size, node-positivity, and Black race were independently associated with disease-specific overall survival.

Conclusion: Worse outcome among Black women appears to be independent of the usual predictors of survival. Further investigation is necessary to identify the cause of this survival disparity. Barriers to completion of standard post-operative treatment regimens may be especially important in this regard.

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Disease-free survival was significantly worse in Black women compared to those of other races (p < .01).
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Figure 1: Disease-free survival was significantly worse in Black women compared to those of other races (p < .01).

Mentions: Factors not predictive of either disease-free or overall survival by univariate analysis included presence of two or more comorbidities, body mass index (BMI) > or ≤ 30, lack of insurance, tumor grade, and hormone receptor status. Univariate factors predicting worse disease-free survival (DFS) included increasing tumor size, node-positivity, Black vs. other race (Figure 1), and non-compliance with adjuvant treatment (Figure 2). When subjected to multivariate analysis, all remained independent predictors of disease-free survival (Table 6). Univariate predictors of overall disease-specific survival included tumor size, node-positivity, and Black vs. other race (Figure 3). Non-compliance was not predictive when disease-specific death was the endpoint (p = .13 and p = .64, respectively). In multivariate analysis, primary tumor size, node-positivity, and Black race were all independent predictors of overall breast cancer specific survival to varying degrees (Table 6).


Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for Black women after breast cancer treatment.

Kim SH, Ferrante J, Won BR, Hameed M - World J Surg Oncol (2008)

Disease-free survival was significantly worse in Black women compared to those of other races (p < .01).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2277417&req=5

Figure 1: Disease-free survival was significantly worse in Black women compared to those of other races (p < .01).
Mentions: Factors not predictive of either disease-free or overall survival by univariate analysis included presence of two or more comorbidities, body mass index (BMI) > or ≤ 30, lack of insurance, tumor grade, and hormone receptor status. Univariate factors predicting worse disease-free survival (DFS) included increasing tumor size, node-positivity, Black vs. other race (Figure 1), and non-compliance with adjuvant treatment (Figure 2). When subjected to multivariate analysis, all remained independent predictors of disease-free survival (Table 6). Univariate predictors of overall disease-specific survival included tumor size, node-positivity, and Black vs. other race (Figure 3). Non-compliance was not predictive when disease-specific death was the endpoint (p = .13 and p = .64, respectively). In multivariate analysis, primary tumor size, node-positivity, and Black race were all independent predictors of overall breast cancer specific survival to varying degrees (Table 6).

Bottom Line: Tumor size, node-positivity, and Black race were independently associated with disease-specific overall survival.Worse outcome among Black women appears to be independent of the usual predictors of survival.Barriers to completion of standard post-operative treatment regimens may be especially important in this regard.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA, 18711, USA. shkim1@geisinger.edu

ABSTRACT

Introduction: Black women appear to have worse outcome after diagnosis and treatment of breast cancer. It is still unclear if this is because Black race is more often associated with known negative prognostic indicators or if it is an independent prognostic factor. To study this, we analyzed a patient cohort from an urban university medical center where these women made up the majority of the patient population.

Methods: We used retrospective analysis of a prospectively collected database of breast cancer patients seen from May 1999 to June 2006. Time to recurrence and survival were analyzed using the Kaplan-Meier method, with statistical analysis by chi-square, log rank testing, and the Cox regression model.

Results: 265 female patients were diagnosed with breast cancer during the time period. Fifty patients (19%) had pure DCIS and 215 patients (81%) had invasive disease. Racial and ethnic composition of the entire cohort was as follows: Black (N = 150, 56.6%), Hispanic (N = 83, 31.3%), Caucasian (N = 26, 9.8%), Asian (N = 4, 1.5%), and Arabic (N = 2, 0.8%). For patients with invasive disease, independent predictors of poor disease-free survival included tumor size, node-positivity, incompletion of adjuvant therapy, and Black race. Tumor size, node-positivity, and Black race were independently associated with disease-specific overall survival.

Conclusion: Worse outcome among Black women appears to be independent of the usual predictors of survival. Further investigation is necessary to identify the cause of this survival disparity. Barriers to completion of standard post-operative treatment regimens may be especially important in this regard.

Show MeSH
Related in: MedlinePlus