Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer
Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer
复制标题
DOI：
10.1093/jnci/djg073
复制
发表时间：
2003-10-15
期刊：
影响因子：
--
通讯作者：
Neugut, AI
中科院分区：
文献类型：
--
作者：
Hershman, D;Weinberg, M;Neugut, AI
在非裔美国人和白色妇女之间观察到乳腺癌生存率的差异。在人种和种族组之间，平均基线白色血细胞（WBC）计数也存在已知差异。如果接受辅助化疗的患者的WBC计数低于常规定义的治疗阈值，则可能会减少剂量或延迟治疗，这可能导致治疗持续时间的种族差异。我们使用哥伦比亚长老会医学中心的肿瘤登记处确定了1178名新诊断为I期和II期乳腺癌的妇女，我们收集了73名非洲裔美国妇女和126名年龄和肿瘤分期匹配的白色妇女的基线信息。在这些妇女中，43名非洲裔美国人和93名白色妇女接受了辅助化疗。非裔美国妇女在诊断时的WBC计数在统计学上显著低于白色妇女（非裔美国妇女为6.2 x 10（9）/L，白色妇女为7.4 x 10（9）/L，差异= 1.2，95%置信区间[CI] = 0.2至1.2; P = 0.02）和治疗后（非裔美国女性为5.3 x 10（9）/L，白色女性为6.4 x 10（9）/L，差异= 1.1，95% CI = 0.2至2.5; P = 0.03）。总体而言，非洲裔美国女性需要的治疗持续时间在统计学上显著长于白色女性（分别为19周vs 15周，差异= 4周，95% CI = 0.5 - 7.2周; P = 0.03）。与白色女性相比，非裔美国女性早期乳腺癌的基线WBC计数较低且治疗持续时间较长，导致非裔美国女性的治疗剂量强度较低，可能导致观察到的乳腺癌生存期种族差异。
Disparities in breast cancer survival have been observed between African American and white women. There are also known differences in mean baseline white blood cell (WBC) count among racial and ethnic groups. If the WBC count falls below conventionally defined treatment thresholds for patients undergoing adjuvant chemotherapy, reduced doses or treatment delays may occur, which could lead to race-based differences in treatment duration. We used the tumor registry at Columbia-Presbyterian Medical Center to identify 1178 women with newly diagnosed stage I and II breast cancer from whom we collected baseline information for 73 African American women and 126 age- and tumor stage-matched white women. Of these women, 43 African American and 93 white women underwent adjuvant chemotherapy. African American women had statistically significantly lower WBC counts than white women at diagnosis (6.2 x 10(9)/L for African American women versus 7.4 x 10(9)/L for white women, difference = 1.2, 95% confidence interval [CI] = 0.2 to 1.2; P = .02) and after treatment (5.3 x 10(9)/L for African American women versus 6.4 x 10(9)/L for white women, difference = 1.1, 95% CI = 0.2 to 2.5; P = .03). Overall, African American women required a statistically significantly longer duration of treatment than white women (19 weeks versus 15 weeks, respectively, difference = 4 weeks, 95% CI = 0.5 to 7.2 weeks; P = .03). The lower baseline WBC counts and longer duration of treatment for early-stage breast cancer in African American women compared with those in white women result in lower dose intensity of treatment for African American women, possibly contributing to observed racial differences in breast cancer survival.