In Reply Dr Braun and colleagues raise several important points. In our study, we did not wish to imply that the natural history of breast cancer is simple or easily understood. Many studies remain to be done.
We recognize the challenge in distinguishing the relative importance of intrinsic factors and social factors vis à vis their contribution to disparities in health care outcomes (in this case, mortality among women with early-stage breast cancer). We entered into this inquiry with no prior hypothesis, and we included whites, blacks, Asians, and Hispanics as comparison groups. The categorization of race/ethnicity was assigned within the Surveillance, Epidemiology, and End Results (SEER) registries, and decisions regarding this assignment were not under our control.
Iqbal J, Rochon P, Ginsburg O. Racial and Ethnic Differences in Breast Cancer Diagnosis and Survival—Reply. JAMA. 2015;313(14):1475-1476. doi:10.1001/jama.2015.2589