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September 28, 1994

Racial Differences in Survival From Breast Cancer: Results of the National Cancer Institute Black/White Cancer Survival Study

Author Affiliations

From the Division of Epidemiology, Emory University School of Public Health, Atlanta, Ga (Drs Eley, Hill, Greenberg, and Coates); Department of Pathology, Louisiana State University Medical Center, New Orleans (Drs Chen and Correa); Oregon Health Department, Portland (Dr Austin); Information Management Services Inc, Silver Spring, Md (Dr Wesley); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (Dr Muss); Department of Biostatistics, University of Pittsburgh (Pa) (Dr Redmond); Office of Research on Women's Health, Bethesda, Md (Dr Hunter); National Institute of Child Health and Human Development, Bethesda, Md (Dr Herman); Departments of Gynecology-Obstetrics and Pathology, The Johns Hopkins University, Baltimore, Md (Dr Kurman); College of Medicine, Northeastern Ohio Universities, Rootstown (Dr Blacklow); The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Mr Shapiro); Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Md (Dr Edwards).

JAMA. 1994;272(12):947-954. doi:10.1001/jama.1994.03520120057031

Objective.  —To examine the ability of recognized prognostic factors for breast cancer to account for the observed poorer survival in blacks compared with their white counterparts.

Design and Participants.  —Subjects included 1130 women (612 blacks and 518 whites) aged 20 to 79 years residing in metropolitan Atlanta, Ga, New Orleans, La, or San Francisco/Oakland, Calif, who were diagnosed with primary invasive breast cancer. Information on stage, tumor characteristics, treatment, comorbid conditions, and sociodemographic factors was obtained from personal interview, physician and hospital records, and a pathology review of biopsy and surgical specimens.

Main Outcome Measure.  —Multivariable survival models were used to estimate the hazard ratio (relative risk of mortality) for blacks compared with whites, adjusting for various combinations of potential explanatory factors.

Results.  —After controlling for geographic site and age, the risk of dying was 2.2 times (95% confidence interval [CI], 1.8 to 2.8) greater for blacks than whites. Adjustment for stage reduced the risk from 2.2 to 1.7; further adjustment for sociodemographic variables had no effect. Treatment was not a contributing factor once stage and tumor pathology were in the model. After adjusting for stage, treatment, comorbid illness, and pathologic and sociodemographic variables, blacks continued to demonstrate a slightly increased, but not statistically significant, risk of death (hazard ratio=1.3; 95% CI, 1.0 to 1.8). Results were similar for all-cause mortality and breast cancer—specific mortality.

Conclusions.  —Approximately 75% of the racial difference in survival was explained by the prognostic factors studied. Sociodemographic variables appeared to act largely through racial differences in stage at diagnosis, which may be amenable to change through improved access to and use of screening for black women.(JAMA. 1994;272:947-954)