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Race and ethnicity and breast cancer outcomes in an underinsured population.
J Natl Cancer Inst. 2010 Aug 04; 102(15):1178-87.JNCI

Abstract

BACKGROUND

The disparity in breast cancer mortality between African American women and non-Hispanic white women has been the subject of increased scrutiny. Few studies have addressed these differences in the setting of equal access to health care. We compared the breast cancer outcomes of underinsured African American and non-Hispanic white patients who were treated at a single institution.

METHODS

We conducted a retrospective review of medical records for breast cancer patients who were treated at Wishard Memorial Hospital from January 1, 1997, to February 28, 2006. A total of 574 patients (259 non-Hispanic whites and 315 African Americans) were evaluated. A Cox proportional hazards regression analysis for competing risks was performed. All statistical tests were two-sided.

RESULTS

Sociodemographic characteristics were similar in the two groups, and both racial groups were equally unlikely to have undergone screening mammography during the 2 years before diagnosis. Most (84%) of the patients were underinsured. The median time from diagnosis to operation, receipt of adequate surgery, and use of all types of adjuvant therapy were similar in the two groups. Median follow-up was 80.3 months for non-Hispanic whites and 77.9 months for African Americans. After accounting for the effect of comorbidities, African American race was statistically significantly associated with breast cancer-specific mortality (African Americans vs non-Hispanic whites: 26.0% vs 17.5%, P = .028; hazard ratio [HR] of death = 1.64, 95% confidence interval [CI] = 1.06 to 2.55). Adjustment for age at diagnosis, clinical stage, and hormone receptor status attenuated the effect, and the effect of race on breast cancer-specific survival was no longer statistically significant (HR of death from breast cancer = 1.43, 95% CI = 0.89 to 2.30). After adjustment for sociodemographic factors, the hazard ratio for race was further attenuated (HR = 1.26; 95% CI = 0.79 to 2.00).

CONCLUSIONS

In this underinsured population, African American patients had poorer breast cancer-specific survival than non-Hispanic white patients. After adjustment for clinical and sociodemographic factors, the effect of race on survival was no longer statistically significant.

Authors+Show Affiliations

Department of Surgery, Indiana University, Indianapolis, IN, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20574040

Citation

Komenaka, Ian K., et al. "Race and Ethnicity and Breast Cancer Outcomes in an Underinsured Population." Journal of the National Cancer Institute, vol. 102, no. 15, 2010, pp. 1178-87.
Komenaka IK, Martinez ME, Pennington RE, et al. Race and ethnicity and breast cancer outcomes in an underinsured population. J Natl Cancer Inst. 2010;102(15):1178-87.
Komenaka, I. K., Martinez, M. E., Pennington, R. E., Hsu, C. H., Clare, S. E., Thompson, P. A., Murphy, C., Zork, N. M., & Goulet, R. J. (2010). Race and ethnicity and breast cancer outcomes in an underinsured population. Journal of the National Cancer Institute, 102(15), 1178-87. https://doi.org/10.1093/jnci/djq215
Komenaka IK, et al. Race and Ethnicity and Breast Cancer Outcomes in an Underinsured Population. J Natl Cancer Inst. 2010 Aug 4;102(15):1178-87. PubMed PMID: 20574040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race and ethnicity and breast cancer outcomes in an underinsured population. AU - Komenaka,Ian K, AU - Martinez,Maria Elena, AU - Pennington,Robert E,Jr AU - Hsu,Chiu-Hsieh, AU - Clare,Susan E, AU - Thompson,Patricia A, AU - Murphy,Colleen, AU - Zork,Noelia M, AU - Goulet,Robert J,Jr Y1 - 2010/06/23/ PY - 2010/6/25/entrez PY - 2010/6/25/pubmed PY - 2010/8/26/medline SP - 1178 EP - 87 JF - Journal of the National Cancer Institute JO - J Natl Cancer Inst VL - 102 IS - 15 N2 - BACKGROUND: The disparity in breast cancer mortality between African American women and non-Hispanic white women has been the subject of increased scrutiny. Few studies have addressed these differences in the setting of equal access to health care. We compared the breast cancer outcomes of underinsured African American and non-Hispanic white patients who were treated at a single institution. METHODS: We conducted a retrospective review of medical records for breast cancer patients who were treated at Wishard Memorial Hospital from January 1, 1997, to February 28, 2006. A total of 574 patients (259 non-Hispanic whites and 315 African Americans) were evaluated. A Cox proportional hazards regression analysis for competing risks was performed. All statistical tests were two-sided. RESULTS: Sociodemographic characteristics were similar in the two groups, and both racial groups were equally unlikely to have undergone screening mammography during the 2 years before diagnosis. Most (84%) of the patients were underinsured. The median time from diagnosis to operation, receipt of adequate surgery, and use of all types of adjuvant therapy were similar in the two groups. Median follow-up was 80.3 months for non-Hispanic whites and 77.9 months for African Americans. After accounting for the effect of comorbidities, African American race was statistically significantly associated with breast cancer-specific mortality (African Americans vs non-Hispanic whites: 26.0% vs 17.5%, P = .028; hazard ratio [HR] of death = 1.64, 95% confidence interval [CI] = 1.06 to 2.55). Adjustment for age at diagnosis, clinical stage, and hormone receptor status attenuated the effect, and the effect of race on breast cancer-specific survival was no longer statistically significant (HR of death from breast cancer = 1.43, 95% CI = 0.89 to 2.30). After adjustment for sociodemographic factors, the hazard ratio for race was further attenuated (HR = 1.26; 95% CI = 0.79 to 2.00). CONCLUSIONS: In this underinsured population, African American patients had poorer breast cancer-specific survival than non-Hispanic white patients. After adjustment for clinical and sociodemographic factors, the effect of race on survival was no longer statistically significant. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/20574040/Race_and_ethnicity_and_breast_cancer_outcomes_in_an_underinsured_population_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djq215 DB - PRIME DP - Unbound Medicine ER -