Infiltrating ductal carcinoma of the breast: the survival impact of race.

PURPOSE Breast cancer has a poorer prognosis among black women than among white women. This review was conducted to determine whether this disparity reflects the direct impact of race on likelihood of cure or on time to death from breast cancer or stems from the interaction of race with tumor stage and patient age. PATIENTS AND METHODS We analyzed data from 115,838 patients with localized (node-negative) and regionally metastatic (node-positive) breast cancer from the Surveillance, Epidemiology, and End-Results (SEER) Program of the National Cancer Institute. Parametric analysis was used to determine the independent prognostic value of age, stage, and race. Linear regression and distribution analyses were also used to examine the interaction of these covariates. RESULTS The prevalence of regionally metastatic disease, relative to localized disease, declined with increased age among white patients and those classified as "other," but remained relatively constant among black patients. Parametric analysis showed a smaller cured fraction and shorter time to death when patients with regional disease were compared with those with localized disease. A similar disparity was found when black patients were compared with those classified as white or other. CONCLUSION Age and race have a significant association with tumor stage. In addition, our data show that race has an independent impact on the clinical course of breast cancer and diminishes both the likelihood of cure and time to death among uncured patients.

[1]  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.

[2]  E. Feuer,et al.  The impact of stage and histology on the long‐term clinical course of 163,808 patients with breast carcinoma , 1996, Cancer.

[3]  M. Province,et al.  Proliferative rate by S‐phase measurement may affect cure of breast carcinoma , 1995, Cancer.

[4]  V. Chen,et al.  Racial disparity in the association of p53 gene alterations with breast cancer survival. , 1995, Cancer research.

[5]  M. Roach,et al.  The prognostic significance of race and survival from breast cancer: a model for assessing the reliability of reported survival differences. , 1995, Journal of the National Medical Association.

[6]  K Smigel,et al.  Breast cancer death rates decline for white women. , 1995, Journal of the National Cancer Institute.

[7]  G. Bonadonna,et al.  Parametric survival analysis of adjuvant therapy for stage II breast cancer , 1994, Cancer.

[8]  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.

[9]  D. Schaid,et al.  Novel pattern of p53 gene mutations in an American black cohort with high mortality from breast cancer , 1994, The Lancet.

[10]  C. Redmond,et al.  Histological characteristics of breast carcinoma in blacks and whites. , 1994, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[11]  L. Garfinkel,et al.  Changing trends: An overview of breast cancer incidence and mortality , 1994, Cancer.

[12]  S. George,et al.  Skin melanoma. Cured fraction and survival time as functions of thickness, site, histologic type, age, and sex , 1993, Cancer.

[13]  B. Kohler,et al.  The Relation between Health Insurance Coverage and Clinical Outcomes among Women with Breast Cancer , 1993 .

[14]  V W Chen,et al.  Treatment plans for black and white women with stage II node‐positive breast cancer: The national cancer institute black/white cancer survival study experience , 1992, Cancer.

[15]  B. Hankey,et al.  Differences between black and white women with breast cancer in time from symptom recognition to medical consultation. Black/White Cancer Survival Study Group. , 1992, Journal of the National Cancer Institute.

[16]  G. Kimmick,et al.  A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer. The piedmont oncology association experience , 1991, Cancer.

[17]  D. Derman,et al.  Lack of a significant independent effect of race on survival in breast cancer , 1988, Cancer.

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

[19]  L. Rutqvist,et al.  Is breast cancer a curable disease? A study of 14,731 women with breast cancer from the cancer registry of Norway , 1984, Cancer.

[20]  M. Palmer,et al.  Distribution of survival times of 12,000 head and neck cancer patients who died with their disease. , 1976, British Journal of Cancer.

[21]  J. Boag,et al.  A test of several parametic statistical models for estimating success rate in the treatment of carcinoma cervix uteri. , 1975, British Journal of Cancer.

[22]  G. Swanson,et al.  Survival patterns among younger women with breast cancer: the effects of age, race, stage, and treatment. , 1994, Journal of the National Cancer Institute. Monographs.

[23]  J. Boag,et al.  Maximum Likelihood Estimates of the Proportion of Patients Cured by Cancer Therapy , 1949 .