Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status.

PURPOSE The extent to which socioeconomic disadvantages and inadequate health care access account for the disproportionately elevated mortality hazard observed in African American compared with white American patients with breast cancer is poorly defined. METHODS We identified 20 studies reported between January 1980 and June 2005 that provided survival analyses in patients with breast cancer after adjusting for ethnicity and some measurement of socioeconomic status. These studies also adjusted for age and stage of disease at time of diagnosis. RESULTS The pooled outcome data yielded estimates for the mortality hazard in 14,013 African American and 76,111 white American patients with breast cancer. Studies varied in their methods for assigning socioeconomic status, with most relying on area-wide measures such as census tract and census block data. The combined analysis (adjusted for age, stage, and socioeconomic status) revealed that African American ethnicity was associated with a statistically significant excess mortality risk in overall survival (mortality hazard, 1.27; 95% CI, 1.18 to 1.38) and in breast cancer-specific survival (mortality hazard, 1.19; 95% CI, 1.10 to 1.29). CONCLUSION Our pooled analysis demonstrated that African American ethnicity is a significant and independent predictor of poor outcome from breast cancer, even after accounting for socioeconomic status by conventional measures. These findings support the need for further investigation of the biologic, genetic, and sociocultural factors that may influence survival in African American patients with breast cancer.

[1]  W. McCaskill-Stevens,et al.  Contralateral breast cancer and thromboembolic events in African American women treated with tamoxifen. , 2004, Journal of the National Cancer Institute.

[2]  V. Shavers,et al.  Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35 , 2003, Cancer.

[3]  N. Risch,et al.  The importance of race and ethnic background in biomedical research and clinical practice. , 2003, The New England journal of medicine.

[4]  P. Sorlie,et al.  The new population standard for age-adjusting death rates. , 2000, Annals of epidemiology.

[5]  D. Nerenz,et al.  Comorbidity and survival disparities among black and white patients with breast cancer. , 2005, JAMA.

[6]  Zhao Chen,et al.  Ethnicity and breast cancer: factors influencing differences in incidence and outcome. , 2005, Journal of the National Cancer Institute.

[7]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[8]  Nilanjan Chatterjee,et al.  Estrogen Receptor Breast Cancer Phenotypes in the Surveillance, Epidemiology, and End Results Database , 2002, Breast Cancer Research and Treatment.

[9]  N. Berger,et al.  Socioeconomic factors and race in breast cancer recurrence and survival. , 1992, American journal of epidemiology.

[10]  E. John,et al.  Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971-1975 to 1992. National Health and Nutrition Examination Survey. , 1999, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[11]  Ahmedin Jemal,et al.  Cancer Disparities by Race/Ethnicity and Socioeconomic Status , 2004, CA: a cancer journal for clinicians.

[12]  S. Kasl,et al.  Prognostic significance of psychosocial factors in African‐American and white breast cancer patients , 2003, Cancer.

[13]  C. C. Johnson,et al.  Race and differences in breast cancer survival in a managed care population. , 1999, Journal of the National Cancer Institute.

[14]  M. Guy,et al.  Vitamin D Receptor Gene Polymorphisms and Breast Cancer Risk , 2004, Clinical Cancer Research.

[15]  Hongzhe Li,et al.  Putative ancestral origins of chromosomal segments in individual african americans: implications for admixture mapping. , 2004, Genome research.

[16]  M. Guy,et al.  Plasma 25-hydroxy vitamin D concentrations, vitamin D receptor genotype and breast cancer risk in a UK Caucasian population. , 2005, European journal of cancer.

[17]  W. G. Cochran.  The combination of estimates from different experiments. , 1954 .

[18]  C B Begg,et al.  Racial differences in the treatment of early-stage lung cancer. , 1999, The New England journal of medicine.

[19]  O. Brawley.  Disaggregating the effects of race and poverty on breast cancer outcomes. , 2002, Journal of the National Cancer Institute.

[20]  R. Severson,et al.  Racial differences in survival of female breast cancer in the detroit metropolitan area , 1996, Cancer.

[21]  R. Coates,et al.  Racial differences in the expression of cell cycle–regulatory proteins in breast carcinoma , 2004, Cancer.

[22]  E. Lander,et al.  Finishing the euchromatic sequence of the human genome , 2004 .

[23]  S. O’Brien,et al.  Markers for mapping by admixture linkage disequilibrium in African American and Hispanic populations. , 2001, American journal of human genetics.

[24]  I. Kawachi,et al.  Social capital, income inequality, and mortality. , 1997, American journal of public health.

[25]  N. Krieger,et al.  Social class and black-white differences in breast cancer survival. , 1986, American journal of public health.

[26]  R. Kuttner.  THE AMERICAN HEALTH CARE SYSTEM : HEALTH INSURANCE COVERAGE , 1999 .

[27]  R. Kittles,et al.  Implications of correlations between skin color and genetic ancestry for biomedical research , 2004, Nature Genetics.

[28]  B. Wójcik,et al.  Breast carcinoma survival analysis for african american and white women in an equal‐access health care system , 1998, Cancer.

[29]  L. Newman,et al.  Breast cancer in African-American women. , 2005, The oncologist.

[30]  R. Severson,et al.  Racial differences in breast cancer survival: the interaction of socioeconomic status and tumor biology. , 1997, American journal of obstetrics and gynecology.

[31]  S. Joslyn.  Racial differences in survival from breast cancer. , 1995, JAMA.

[32]  Ichiro Kawachi,et al.  Income inequality and health: what have we learned so far? , 2004, Epidemiologic reviews.

[33]  J. Cox,et al.  Breast cancer: Is ethnicity an independent prognostic factor for survival? , 1996, Cancer.

[34]  R. Coates,et al.  Race, nutritional status, and survival from breast cancer. , 1990, Journal of the National Cancer Institute.

[35]  A. Neugut,et al.  Ethnic neutropenia and treatment delay in African American women undergoing chemotherapy for early-stage breast cancer. , 2003, Journal of the National Cancer Institute.

[36]  N. Breen,et al.  The relationship of socio-economic status and access to minimum expected therapy among female breast cancer patients in the National Cancer Institute Black-White Cancer Survival Study. , 1999, Ethnicity & disease.

[37]  M. Simon,et al.  Racial disparities in treatment and survival of women with stage I–III breast cancer at a large academic medical center in metropolitan Detroit , 2005, Breast Cancer Research and Treatment.

[38]  G. Colditz,et al.  African‐American ethnicity, socioeconomic status, and breast cancer survival , 2002, Cancer.

[39]  S. Singletary,et al.  Effects of race and socioeconomic status on survival of 1,332 black, hispanic, and white women with breast cancer , 1997, Annals of Surgical Oncology.

[40]  S. Grundfest-Broniatowski,et al.  Race is a Fundamental Prognostic Indicator for 2325 Northeastern Ohio Women with Infiltrating Breast Cancer , 2005, The breast journal.

[41]  C. Hoggart,et al.  Design and analysis of admixture mapping studies. , 2004, American journal of human genetics.

[42]  R. Penchansky,et al.  Disaggregating the effects of race on breast cancer survival. , 1998, Family medicine.

[43]  T. Dyer,et al.  Admixture effects in the traditional linkage analysis of admixed families. , 2002, Ethnicity & disease.

[44]  O. Olopade,et al.  Breast cancer genetics in African Americans , 2003, Cancer.

[45]  J. Krischer,et al.  Effects of health insurance and race on breast carcinoma treatments and outcomes , 2000, Cancer.

[46]  K. Malone,et al.  Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. , 2002, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[47]  Cathy J Bradley,et al.  Race, socioeconomic status, and breast cancer treatment and survival. , 2002, Journal of the National Cancer Institute.

[48]  L. Newman,et al.  Breast cancer in sub‐Saharan Africa: How does it relate to breast cancer in African‐American women? , 2005, Cancer.

[49]  L. Gordis,et al.  Assessment of a national health interview survey-based method of measuring community socioeconomic status. , 2003, Annals of epidemiology.

[50]  B. Tilley,et al.  Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer , 1985, Cancer.

[51]  A. Polednak.  Survival of breast cancer patients in Connecticut in relation to socioeconomic and health care access indicators , 2002, Journal of Urban Health.

[52]  D. Ansell,et al.  Race, income, and survival from breast cancer at two public hospitals , 1993, Cancer.

[53]  M. Cogswell,et al.  Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988-1994. , 2002, The American journal of clinical nutrition.

[54]  Indiana Strombom,et al.  Socioeconomic Risk Factors for Breast Cancer: Distinguishing Individual- and Community-Level Effects , 2004, Epidemiology.

[55]  Li Jin,et al.  Skin pigmentation, biogeographical ancestry and admixture mapping , 2003, Human Genetics.

[56]  K. Cheng,et al.  Social deprivation and breast cancer. , 2003, Journal of public health medicine.

[57]  A. Matakidou,et al.  Thymidylate synthase expression and prognosis in colorectal cancer: a systematic review and meta-analysis. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[58]  A. Recht,et al.  Race, socioeconomic status, and breast carcinoma in the U.S. , 2002, Cancer.

[59]  P. Commiskey,et al.  Socioeconomic factors and breast carcinoma in multicultural women , 2000, Cancer.

[60]  F Mosteller,et al.  Meta-analysis of multiple outcomes by regression with random effects. , 1998, Statistics in medicine.

[61]  J. Dignam.  Efficacy of systemic adjuvant therapy for breast cancer in African-American and Caucasian women. , 2001, Journal of the National Cancer Institute. Monographs.

[62]  J. Cunningham,et al.  Racial disparities in female breast cancer in South Carolina: clinical evidence for a biological basis , 2004, Breast Cancer Research and Treatment.

[63]  J. Carpten,et al.  African-American heredity prostate cancer study: a model for genetic research. , 2001, Journal of the National Medical Association.

[64]  G A Colditz,et al.  Understanding research synthesis (meta-analysis). , 1996, Annual review of public health.

[65]  D. Cox.  Regression Models and Life-Tables , 1972 .

[66]  N. Krieger.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. , 1992, American journal of public health.

[67]  H. Becher,et al.  Widening disparity in survival between white and African‐American patients with breast carcinoma treated in the U. S. Department of Defense Healthcare system , 2003, Cancer.

[68]  H. Muss.  Factors used to select adjuvant therapy of breast cancer in the United States: an overview of age, race, and socioeconomic status. , 2001, Journal of the National Cancer Institute. Monographs.

[69]  J. Carpten,et al.  Recruitment experience in the first phase of the African American Hereditary Prostate Cancer (AAHPC) study. , 2000, Annals of epidemiology.

[70]  D. Berry,et al.  Race and survival from breast cancer: based on Cancer and Leukemia Group B trial 8541. , 1997, The cancer journal from Scientific American.

[71]  G. Colditz,et al.  Social networks and health-related quality of life in breast cancer survivors: a prospective study. , 2002, Journal of psychosomatic research.

[72]  A. Neale.  Racial and marital status influences on 10 year survival from breast cancer. , 1994, Journal of clinical epidemiology.

[73]  C. Howe,et al.  African‐American/White differences in breast carcinoma , 2004, Cancer.

[74]  C. Perou,et al.  Hormone receptor negative and basal-like subtypes are overrepresented in invasive breast carcinoma from women of African ancestry , 2005 .

[75]  C K Redmond,et al.  Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. , 1994, JAMA.

[76]  J. V. Moran,et al.  Initial sequencing and analysis of the human genome. , 2001, Nature.

[77]  R. Wait,et al.  Is race a poor prognostic factor in breast cancer? , 1999, Journal of the American College of Surgeons.