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Racial Disparities in the Clinical Presentation and Prognosis of Patients with Mycosis Fungoides.

Abstract

OBJECTIVE

Racial and gender disparities in mycosis fungoides (MF) are understudied. The objective of this study was to test the hypothesis that worse prognosis in blacks with MF is mediated by higher disease stage at diagnosis and by earlier disease onset in black females.

METHODS

We conducted retrospective chart review of 337 patients with clinically-suspected MF seen at Johns Hopkins between 2003 and 2018, requiring biopsy-proven disease for study inclusion. Patient demographics, initial stage/percent body surface area (BSA) involvement, pathology type, flow cytometry results, and treatment regimens were recorded.

RESULTS

Of 303 patients with confirmed MF, 166 (55%) were white, 107 (35%) black, 10 (3.3%) Middle Eastern, 6 (2.0%) Asian, and 14 (4.6%) Hispanic/other. Blacks were 3 times as likely (95% CI: 1.2, 8.0) to have Stage 2 disease to have Stage 2 disease at diagnosis as compared to whites as whites. In females, blacks were younger at diagnosis (p = 0.003) and at death (p = 0.008) compared to whites. In males, blacks had 4 times the odds of late-stage disease (p = 0.017) and presented with 19% greater BSA involvement on average compared to whites (p < 0.001).

CONCLUSIONS

Compared to their white counterparts in this cohort, black males were diagnosed with MF at a higher stage with greater skin involvement while black females were diagnosed and died earlier. Earlier recognition of MF in skin of color and closer follow-up of black females with early-onset, aggressive disease may help to mitigate disparities in outcomes.

Authors+Show Affiliations

Department of Dermatology, Johns Hopkins University School of Medicine, USA; Bloomberg School of Public Health, Johns Hopkins University, USA.Department of Dermatology, Johns Hopkins University School of Medicine, USA; Bloomberg School of Public Health, Johns Hopkins University, USA. Electronic address: skwatra1@jhmi.edu.Department of Dermatology, Johns Hopkins University School of Medicine, USA.Division of Dermatology, Washington University School of Medicine in St. Louis, USA.Department of Dermatology, Howard University School of Medicine, USA.Department of Dermatology, Johns Hopkins University School of Medicine, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31623818

Citation

Huang, Amy H., et al. "Racial Disparities in the Clinical Presentation and Prognosis of Patients With Mycosis Fungoides." Journal of the National Medical Association, 2019.
Huang AH, Kwatra SG, Khanna R, et al. Racial Disparities in the Clinical Presentation and Prognosis of Patients with Mycosis Fungoides. J Natl Med Assoc. 2019.
Huang, A. H., Kwatra, S. G., Khanna, R., Semenov, Y. R., Okoye, G. A., & Sweren, R. J. (2019). Racial Disparities in the Clinical Presentation and Prognosis of Patients with Mycosis Fungoides. Journal of the National Medical Association, doi:10.1016/j.jnma.2019.08.006.
Huang AH, et al. Racial Disparities in the Clinical Presentation and Prognosis of Patients With Mycosis Fungoides. J Natl Med Assoc. 2019 Oct 14; PubMed PMID: 31623818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial Disparities in the Clinical Presentation and Prognosis of Patients with Mycosis Fungoides. AU - Huang,Amy H, AU - Kwatra,Shawn G, AU - Khanna,Raveena, AU - Semenov,Yevgeniy R, AU - Okoye,Ginette A, AU - Sweren,Ronald J, Y1 - 2019/10/14/ PY - 2019/06/29/received PY - 2019/07/15/revised PY - 2019/08/13/accepted PY - 2019/10/19/entrez KW - Disparities KW - Gender KW - Mycosis fungoides KW - Race JF - Journal of the National Medical Association JO - J Natl Med Assoc N2 - OBJECTIVE: Racial and gender disparities in mycosis fungoides (MF) are understudied. The objective of this study was to test the hypothesis that worse prognosis in blacks with MF is mediated by higher disease stage at diagnosis and by earlier disease onset in black females. METHODS: We conducted retrospective chart review of 337 patients with clinically-suspected MF seen at Johns Hopkins between 2003 and 2018, requiring biopsy-proven disease for study inclusion. Patient demographics, initial stage/percent body surface area (BSA) involvement, pathology type, flow cytometry results, and treatment regimens were recorded. RESULTS: Of 303 patients with confirmed MF, 166 (55%) were white, 107 (35%) black, 10 (3.3%) Middle Eastern, 6 (2.0%) Asian, and 14 (4.6%) Hispanic/other. Blacks were 3 times as likely (95% CI: 1.2, 8.0) to have Stage 2 disease to have Stage 2 disease at diagnosis as compared to whites as whites. In females, blacks were younger at diagnosis (p = 0.003) and at death (p = 0.008) compared to whites. In males, blacks had 4 times the odds of late-stage disease (p = 0.017) and presented with 19% greater BSA involvement on average compared to whites (p < 0.001). CONCLUSIONS: Compared to their white counterparts in this cohort, black males were diagnosed with MF at a higher stage with greater skin involvement while black females were diagnosed and died earlier. Earlier recognition of MF in skin of color and closer follow-up of black females with early-onset, aggressive disease may help to mitigate disparities in outcomes. SN - 1943-4693 UR - https://www.unboundmedicine.com/medline/citation/31623818/Racial_Disparities_in_the_Clinical_Presentation_and_Prognosis_of_Patients_with_Mycosis_Fungoides L2 - https://linkinghub.elsevier.com/retrieve/pii/S0027-9684(19)30209-3 DB - PRIME DP - Unbound Medicine ER -