Method of detection and breast cancer survival disparities in Hispanic women.
Method of detection and breast cancer survival disparities in Hispanic women.
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DOI：
10.1158/1055-9965.epi-10-0164
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发表时间：
2010-10
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影响因子：
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通讯作者：
Rosenberg RD
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文献类型：
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作者：
Hill DA;Nibbe A;Royce ME;Wallace AM;Kang H;Wiggins CL;Rosenberg RD
新墨西哥州 (NM) 的西班牙裔女性比非西班牙裔女性更有可能死于乳腺癌相关原因。我们确定了西班牙裔和非西班牙裔女性之间的生存差异是否可能归因于检测方法，这是先前研究中的独立乳腺癌预后因素。从 NM 流行病学监测最终结果 (SEER) 文件 (n=5067) 中识别出 1995 年至 2004 年诊断出患有浸润性乳腺癌的白人女性，并与 NM 乳房 X 线摄影项目记录进行匹配。癌症检测方法分为“症状检测”或“筛查检测”。使用 Cox 模型评估了包含变量所占西班牙裔生存差异的比例。在中位随访 87 个月期间，有 490 人死于乳腺癌。 3891 名女性 (76.8%) 的症状与筛查检测可进行分类，并且与乳腺癌特异性生存率独立相关（风险比 (HR) 1.6；95% 置信区间 (CI) 1.3-2.0）。相对于非西班牙裔女性，西班牙裔女性乳腺癌相关死亡的风险增加 1.5 倍（95% CI 1.2-1.8）。调整检测方法后，西班牙裔HR从1.50下降至1.45（10%），但纳入其他预后指标后，西班牙裔HR=1.23（95% CI 1.01-1.48）。尽管调整后西班牙裔 HR 下降了 50%，但下降的主要原因是不良的肿瘤预后特征。西班牙裔女性不同生存率的降低可能不仅依赖于无症状时肿瘤检测的增加，而且依赖于对导致肿瘤预后不良的生物学因素的更深入的了解。
Hispanic women in New Mexico (NM) are more likely to die of breast cancer-related causes than non-Hispanic women. We determined whether survival differences between Hispanic and non-Hispanic women might be attributable to the method of detection, an independent breast cancer prognostic factor in previous studies. White women diagnosed with invasive breast cancer from 1995 through 2004 were identified from NM Surveillance Epidemiology End Results (SEER) files (n=5067), and matched to NM Mammography Project records. Method of cancer detection was categorized as “symptomatic” or “screen-detected”. The proportion of Hispanic survival disparity accounted for by included variables was assessed using Cox models. During 87 months median follow-up, 490 breast cancer deaths occurred. Symptomatic vs. screen-detection was classifiable for 3891 women (76.8%), and was independently related to breast cancer-specific survival (Hazard ratio (HR) 1.6; 95% confidence interval (CI) 1.3–2.0). Hispanic women had a 1.5-fold increased risk of breast cancer-related death, relative to non-Hispanic women (95% CI 1.2–1.8). After adjustment for detection method, the Hispanic HR declined from 1.50 to 1.45 (10%), but after inclusion of other prognostic indicators, the Hispanic HR=1.23 (95% CI 1.01–1.48). Although the Hispanic HR declined 50% after adjustment, the decrease was largely due to adverse tumor prognostic characteristics. Reduction of disparate survival in Hispanic women may rely not only on increased detection of tumors when asymptomatic but on development of greater understanding of biological factors that predispose to poor prognosis tumors.