Ethnicity and breast cancer: Factors influencing differences in incidence and outcome
Ethnicity and breast cancer: Factors influencing differences in incidence and outcome
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DOI：
10.1093/jnci/dji064
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发表时间：
2005-03-16
影响因子：
10.3
通讯作者：
Prentice, R
中科院分区：
文献类型：
--
作者：
Chlebowski, RT;Chen, Z;Prentice, R
背景少数族裔妇女乳腺癌发病率较低，非裔美国妇女乳腺癌死亡率高于白色妇女，这在很大程度上是无法解释的。乳腺癌危险因素对这些差异的影响很少受到关注。研究方法：在156570名参加妇女健康倡议的绝经后妇女中，研究了乳腺癌发病率和结局的种族/民族差异。收集了乳腺癌危险因素的详细信息，包括乳房X线摄影，并对参与者进行了乳腺癌发病率，病理乳腺癌特征和乳腺癌死亡率的前瞻性随访。根据考克斯比例风险模型，以风险比（HR）和95%置信区间（Cls）估计不同种族/民族乳腺癌发病率和死亡率的比较。在逻辑回归模型中比较肿瘤特征的优势比（OR）和95%置信区间。结果：在中位随访6.3年后，诊断出3938例乳腺癌。所有少数群体的经性别调整的发病率（即，非裔美国人、西班牙裔、美洲印第安人/阿拉斯加原住民和亚洲/太平洋岛民）低于白色女性，但乳腺癌风险因素调整解释了除非裔美国人（HR = 0.75，95% CI = 0.61 - 0.92）外的所有差异，分别对应于非裔美国人和白色女性的29例和44例/10000人年。非裔美国妇女的乳腺癌有不利的特点; 32%的非裔美国人，但只有10%的白人都是高级别和雌激素受体阴性（调整OR = 4.70，95%CI = 3.12至7.09）。此外，在调整预后因素后，非裔美国女性乳腺癌后的死亡率高于白色女性（HR = 1.79，95% CI = 1.05至3.05），分别对应于非裔美国女性和白色女性中每10000人-年有9例和6例死亡。结论：大多数种族/民族之间乳腺癌发病率的差异在很大程度上是由风险因素分布解释的，但非洲裔美国人除外。然而，非裔美国妇女的乳腺癌更常见的特征是预后不良，这可能导致其诊断后死亡率增加。
Background. The lower breast cancer incidence in minority women and the higher breast cancer mortality in African American women than in white women are largely unexplained. The influence of breast cancer risk factors on these differences has received little attention. Methods: Racial/ethnic differences in breast cancer incidence and outcome were examined in 156570 postmenopausal women participating in the Women's Health Initiative. Detailed information on breast cancer risk factors including mammography was collected, and participants were followed prospectively for breast cancer incidence, pathological breast cancer characteristics, and breast cancer mortality. Comparisons of breast cancer incidence and mortality across raciat/ethnic groups were estimated as hazard ratios (HRs) and 95% confidence intervals (Cls) from Cox proportional hazard models. Tumor characteristics were compared as odds ratios (ORs) and 95% confidence intervals in logistic regression models. Results: After median follow-up of 6.3 years, 3938 breast cancers were diagnosed. Age-adjusted incidences for all minority groups (i.e., African American, Hispanic, American Indian/Alaskan Native, and Asian/Pacific Islander) were lower than for white women, but adjustment for breast cancer risk factors accounted for the differences for all but African Americans (HR = 0.75, 95% CI = 0.61 to 0.92) corresponding to 29 cases and 44 cases per 10000 person years for African American and white women, respectively. Breast cancers in African American women had unfavorable characteristics; 32% of those in African Americans but only 10% in whites were both high grade and estrogen receptor negative (adjusted OR = 4.70, 95% CI = 3.12 to 7.09). Moreover, after adjustment for prognostic factors, African American women had higher mortality after breast cancer than white women (HR = 1.79, 95% Cl = 1.05 to 3.05) corresponding to nine and six deaths per 10 000 person-years from diagnosis in African American and white women, respectively. Conclusion: Differences in breast cancer incidence rates between most racial/ethnic groups were largely explained by risk factor distribution except in African Americans. However, breast cancers in African American women more commonly had characteristics of poor prognosis, which may contribute to their increased mortality after diagnosis.