Ethnic disparities in breast cancer management among Asian Americans and Pacific Islanders
Ethnic disparities in breast cancer management among Asian Americans and Pacific Islanders
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DOI：
10.1245/aso.2006.08.036
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发表时间：
2006-07-01
影响因子：
3.7
通讯作者：
Seto, Todd B.
中科院分区：
文献类型：
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作者：
Gelber, Rebecca P.;McCarthy, Ellen P.;Seto, Todd B.
背景资料：对亚裔美国人和太平洋岛民（AAPI）乳腺癌的管理知之甚少。方法：我们对2030名女性进行了回顾性分析（935名日本人、144名中国人、235名菲律宾人、293名夏威夷人和423名白色人;平均年龄+/- SD，59 +/- 13岁），1995年至2001年在夏威夷诊断为早期乳腺癌（I、II和IIIA期）。我们将监测、流行病学和最终结果项目的夏威夷肿瘤登记处的数据与行政卫生保健索赔联系起来。我们评估了（1）保乳手术（BCS）;（2）保乳手术后的放疗;（3）淋巴结阳性疾病的化疗。我们使用logistic回归分析来研究AAPI种族和治疗之间的关联，调整年龄，年份，农村居住，肿瘤大小，等级，淋巴结状态，受体状态，既往癌症，合并症指数，健康计划类型和income.Results：总体而言，60.3%的妇女有I期疾病，36.8%有II期，2.9%有IIIA期。只有55.6%的妇女接受了BCS治疗，其中85.1%的妇女还接受了放射治疗。在淋巴结受累的患者（n = 521）中，82.7%接受了化疗。日本和菲律宾妇女比白色妇女明显更不可能接受BCS（日本：调整后的比值比，0.62; 95%置信区间，0.48-0.80;菲律宾：调整后的比值比，0.47; 95%置信区间，0.33-0.66）。菲律宾人在BCS后接受放射治疗的可能性往往低于白色妇女（调整后的比值比为0.80; 95%置信区间为0.42-1.49）。AAPI女性与白色女性一样有可能接受辅助化疗以治疗淋巴结扩散。结论：我们发现AAPI女性在早期乳腺癌的管理方面存在差异，特别是在日本人和菲律宾人中。需要进一步研究，以确定观察到的差异的原因，并了解其对健康结果的影响。
Background: Little is known about breast cancer management among Asian Americans and Pacific Islanders (AAPI).Methods: We performed a retrospective analysis of 2030 women (935 Japanese, 144 Chinese, 235 Filipino, 293 Hawaiian, and 423 white; mean age +/- SD, 59 +/- 13 years) with a diagnosis of early breast cancer (stages I, II, and IIIA) in Hawaii from 1995 to 2001. We linked data from the Surveillance, Epidemiology, and End Results program's Hawaii Tumor Registry to administrative health care claims. We evaluated (1) breast-conserving surgery (BCS); (2) radiotherapy after BCS; and (3) chemotherapy for node-positive disease. We used logistic regression to examine the association between AAPI ethnicity and treatment, adjusting for age, year, rural residence, tumor size, grade, nodal status, receptor status, prior cancer, comorbidity index, health plan type, and income.Results: Overall, 60.3% of women had stage I disease, 36.8% had stage II, and 2.9% had stage IIIA. Only 55.6% received BCS, and 85.1% of these women also received radiation. Of those with nodal involvement (n = 521), 82.7% received chemotherapy. Japanese and Filipino women were significantly less likely than white women to undergo BCS (for Japanese: adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80; for Filipinos: adjusted odds ratio, 0.47; 95% confidence interval, 0.33-0.66). Filipinos tended to be less likely than white women to receive radiation after BCS (adjusted odds ratio, 0.80; 95% confidence interval, 0.42-1.49). AAPI women were as likely as white women to receive adjuvant chemotherapy for nodal spread.Conclusions: We found disparities in the management of early-stage breast cancer among AAPI women, particularly among Japanese and Filipinos. Further study is needed to determine the reasons for the observed disparities and to understand their effect on health outcomes.