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Disparities and Survival Among Breast Cancer Patients
Affiliations of authors: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Foundation, and Fallon Community Health Plan, Worcester, MA (TSF, CD, HF); Center for Health Studies, Group Health Cooperative, Seattle, WA (DSMB, GH); Center for Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (SE, JY); Clinical Research Unit, Kaiser Permanente Colorado, Denver, CO (EJK, JE); Center for Health Services Research, Henry Ford Health System, Detroit, MI (LL, RK); Center for Health Research, Northwest/Hawaii, Kaiser Permanente Northwest, Portland, OR (DJB, MCH); Division of Research, Kaiser Permanente Northern California, Oakland, CA (LH, LL)
Correspondence to: Terry S. Field, DSc, Meyers Primary Care Institute, 630 Plantation St., Worcester, MA 01605 (e-mail: tfield{at}meyersprimary.org).
Background: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased. Purpose: To determine whether this survival disparity persists in an insured population with access to medical care. Methods: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, through December 31, 1998. Cox proportional hazards regression was used to estimate the death rate among African American women relative to that of white women after adjustment for potential explanatory factors including stage at diagnosis, tumor characteristics, and treatment. Results: Five-year survival was lower for African American women (73.8%) than for white women (81.6%). African American women were less likely to have tumor characteristics with good prognosis. Controlling for age at diagnosis, stage, grade, tumor size, and estrogen and progesterone receptor status, the adjusted hazard rate ratio for African American women was 1.34 (95% confidence interval = 1.22 to 1.46). Similar risks were found among women ages 20–49 and 50 and older. Controlling for treatment slightly lowered the hazard rate ratio to 1.31 (95% confidence interval = 1.20 to 1.43). Conclusions: Among women with invasive breast cancer, being insured and having access to medical care does not eliminate the survival disparity for African American women.
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