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Editor's Correspondence
May 26, 2003

Difference in Breast Cancer Stage, Treatment, and Survival

Arch Intern Med. 2003;163(10):1241-1242. doi:10.1001/archinte.163.10.1241

Li et al1 reported that non-Hispanic whites, blacks, American Indians, Hawaiians, Indians and Pakistanis, South and Central Americans, and Puerto Ricans had 1.4- to 3.6-fold greater risks of presenting with stage IV breast cancer and had 20% to 200% greater risks of mortality after a breast cancer diagnosis. They conclude that a combination of socioeconomic and lifestyle factors, and possibly tumor characteristics, are likely to contribute to the differences in stage at breast cancer presentation and survival rates by race and ethnicity, but these results are able to be checked in continents, nations, and regions. Differences in survival have been reported among American and European breast cancer patients. Europeans had a significantly lower 5-year relative survival rates compared with Americans (73% vs 82%).2 Moreover, differences in stage and therapy were reported across Europe, where Estonia, England, and Spain had the most advanced stage at diagnosis (39.3%, 21.1%, and 16.2%, respectively).3 Also, in Italy, there are many differences in breast cancer survival rates and stage at diagnosis, and in southern Italy survival is lower (eg, 70% in Ragusa) than in the northern regions of Italy (eg, 80% in Varese).4 One of the major reasons for this lower survival rate is that in southern Italy there is a lack of medical structures such as primary care facilities, hospital beds, radiotherapy facilities, and teaching universities. Because of these factors, the women of southern Italy are medically underserved compared with those living in northern Italy, and in addition, there was reported a delay in obtaining definitive breast cancer treatment. A recent study5 reported that patient delay was associated with education: a higher risk of breast cancer was found for women with less than 5 years of school attendance (odds ratio [OR], 3.3; 95% confidence interval [CI], 2.0-5.6). In the same study, medical delay was associated with the type of professional involved in the first medical consultation: a higher risk was found in patients examined by a general practitioner or physician other than a senologist (OR, 2.2; 95% CI, 1.4-3.6).5 Also, a previous study in southern Italy had reported a significant association between more advanced stage of breast cancer and residence in rural municipalities (OR, 2.3; 95% CI, 1.1-4.5).6

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