Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer | Breast Cancer | JAMA | JAMA Network
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Original Investigation
July 24/31, 2013

Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer

Author Affiliations
  • 1Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Leonard and Madlyn Abramson Cancer Center of the University of Pennsylvania, Philadelphia
  • 3Departments of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, and Division of Pediatric Oncology, The Children’s Hospital of Philadelphia
  • 4Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine
  • 5Department of Health Care Management, The Wharton School, University of Pennsylvania
  • 6The Leonard Davis Institute of Health Economics, University of Pennsylvania
  • 7Department of Statistics, The Wharton School
  • 8Division of Medical Oncology, the Hospital of the University of Pennsylvania, Philadelphia, and Department of Medicine, University of Pennsylvania Perelman School of Medicine
JAMA. 2013;310(4):389-397. doi:10.1001/jama.2013.8272

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.