Differences in Breast Cancer Stage at Diagnosis and Cancer-Specific Survival by Race and Ethnicity in the United States
Differences in Breast Cancer Stage at Diagnosis and Cancer-Specific Survival by Race and Ethnicity in the United States
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DOI：
10.1001/jama.2014.17322
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发表时间：
2015-01-13
影响因子：
120.7
通讯作者：
Narod, Steven A.
中科院分区：
文献类型：
--
作者：
Iqbal, Javaid;Ginsburg, Ophira;Narod, Steven A.
患有早期乳腺癌的女性预计会有很好的生存率。确定早期乳腺癌诊断的预测因素是很重要的。目的确定不同种族/民族中早期（I期）乳腺癌的比例，以及是否可以通过早期检测或肿瘤侵袭性的内在生物学差异更好地解释种族差异。研究对象：2004年至2011年诊断为浸润性乳腺癌的女性，这些女性在监测、流行病学和最终结果（SEER）18登记数据库中被确定（N = 452 215）。对于8个人种/种族组中的每一个，估计了2.0 cm或更小的小尺寸肿瘤的生物侵袭性（三阴性癌症、淋巴结转移和远处转移）。确定了在I期被诊断为晚期乳腺癌的比值比（OR）和按种族/民族划分的I期乳腺癌死亡的风险比（HR）。最终随访日期为2011年12月31日。主要结果和指标诊断时的乳腺癌分期和7年乳腺癌特异性生存率，经诊断时的年龄、收入和雌激素受体状态调整。（71.9%）为非西班牙裔白色人; 34928（9.4%）为西班牙裔白色人; 38751（10.4%）为黑人; 25211（6.7%）为亚洲人; 5998（1.6%）为其他种族。平均随访时间为40.6个月（中位数，38个月）。与非西班牙裔白色女性（50.8%）相比，日本女性（56.1%）更容易被诊断为I期乳腺癌（OR，1.23 [95%CI，1.15-1.31]，P
IMPORTANCE Women with early-stage breast cancers are expected to have excellent survival rates. It is important to identify factors that predict diagnosis of early-stage breast cancers.OBJECTIVE To determine the proportion of breast cancers that were identified at an early stage (stage I) in different racial/ethnic groups and whether ethnic differences may be better explained by early detection or by intrinsic biological differences in tumor aggressiveness.DESIGN, SETTING, AND PARTICIPANTS Observational study of women diagnosed with invasive breast cancer from 2004 to 2011 who were identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (N = 452 215). For each of 8 racial/ethnic groups, biological aggressiveness (triple-negative cancers, lymph node metastases, and distant metastases) of small-sized tumors of 2.0 cm or less was estimated. The odds ratio (OR) for being diagnosed at stage I compared with a later stage and the hazard ratio (HR) for death from stage I breast cancer by racial/ethnic group were determined. The date of final follow-up was December 31, 2011.MAIN OUTCOMES AND MEASURES Breast cancer stage at diagnosis and 7-year breast cancer-specific survival, adjusted for age at diagnosis, income, and estrogen receptor status.RESULTS Of 373 563 women with invasive breast cancer, 268 675 (71.9%) were non-Hispanic white; 34 928 (9.4%), Hispanic white; 38 751 (10.4%), black; 25 211 (6.7%), Asian; and 5998 (1.6%), other ethnicities. Mean follow-up time was 40.6 months (median, 38 months). Compared with non-Hispanic white women diagnosed with stage I breast cancer (50.8%), Japanese women (56.1%) were more likely to be diagnosed (OR, 1.23 [95% CI, 1.15-1.31], P