Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer
Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer
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DOI：
10.1001/jama.2013.8272
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发表时间：
2013-07-24
影响因子：
120.7
通讯作者：
Fox, Kevin R.
中科院分区：
文献类型：
--
作者：
Silber, Jeffrey H.;Rosenbaum, Paul R.;Fox, Kevin R.
重要性乳腺癌生存率的种族差异是一个公认的问题之间的医疗保险beneficiaries. ObjectiveTo确定是否种族差异在乳腺癌生存主要是由于在诊断或随后的治疗表现特征的差异。比较1991年至2005年诊断的7375名65岁及以上黑人女性和从99898名白色潜在对照中选择的3组7375名匹配的白色对照患者，使用SEER-Medicare数据库中16个美国监测、流行病学和最终结果（SEER）站点的数据。所有患者均接受随访至2009年12月31日，黑人病例患者与3个白色对照人群在人口统计学上匹配（年龄、诊断年份和SEER部位），表现（人口统计学变量加上患者共病状况和肿瘤特征，如分期、大小、分级和雌激素受体状态）和治疗主要结果和指标：5年生存率。（黑人，55.9%;白人，68.8%）为12.9%（95% CI，11.5%-14.5%; P <0.001）。这一差距在1991年至2005年期间保持不变。在临床表现特征匹配后，5年生存率的绝对差异为4.4%（95%CI，2.8%-5.8%; P < .001），黑人比同样接受治疗的白人低3.6%（95%CI，2.3%-4.9%; P < .001）。在陈述比赛中，（87.4% vs 91.8%; P < .001），从诊断到治疗的时间较长（29.2 vs 22.8天; P < .001），蒽环类和紫杉醇类的使用率较低（3.7%比5.0%; P <0.001），而不经其他治疗的保乳手术更常见（8.2%比7.3%; P = 0.04）。然而，与治疗差异相关的生存差异仅占0.81%的12.9%的生存differentiation.CONCLUSIONS和RELEVANCE在SEER医疗数据库中，黑人和白色妇女之间的乳腺癌生存差异并没有实质性变化，在1991年和2005年之间诊断的妇女。这些生存差异似乎主要与诊断时的表现特征有关，而不是与治疗差异有关。
IMPORTANCE Difference in breast cancer survival by race is a recognized problem among Medicare beneficiaries.OBJECTIVE To determine if racial disparity in breast cancer survival is primarily attributable to differences in presentation characteristics at diagnosis or subsequent treatment.DESIGN, SETTING, AND PATIENTS Comparison of 7375 black women 65 years and older diagnosed between 1991 to 2005 and 3 sets of 7375 matched white control patients selected from 99 898 white potential controls, using data for 16 US Surveillance, Epidemiology and End Results (SEER) sites in the SEER-Medicare database. All patients received follow-up through December 31, 2009, and the black case patients were matched to 3 white control populations on demographics (age, year of diagnosis, and SEER site), presentation (demographics variables plus patient comorbid conditions and tumor characteristics such as stage, size, grade, and estrogen receptor status), and treatment (presentation variables plus details of surgery, radiation therapy, and chemotherapy).MAIN OUTCOMES AND MEASURES 5-Year survival.RESULTS The absolute difference in 5-year survival (blacks, 55.9%; whites, 68.8%) was 12.9% (95% CI, 11.5%-14.5%; P < .001) in the demographics match. This difference remained unchanged between 1991 and 2005. After matching on presentation characteristics, the absolute difference in 5-year survival was 4.4%(95% CI, 2.8%-5.8%; P < .001) and was 3.6% (95% CI, 2.3%-4.9%; P < .001) lower for blacks than for whites matched also on treatment. In the presentation match, fewer blacks received treatment (87.4% vs 91.8%; P < .001), time from diagnosis to treatment was longer (29.2 vs 22.8 days; P < .001), use of anthracyclines and taxols was lower (3.7% vs 5.0%; P < .001), and breast-conserving surgery without other treatment was more frequent (8.2% vs 7.3%; P = .04). Nevertheless, differences in survival associated with treatment differences accounted for only 0.81% of the 12.9% survival difference.CONCLUSIONS AND RELEVANCE In the SEER-Medicare database, differences in breast cancer survival between black and white women did not substantially change among women diagnosed between 1991 and 2005. These differences in survival appear primarily related to presentation characteristics at diagnosis rather than treatment differences.