Lindsay J Collin1,2, Ming Yan1, Renjian Jiang1,3, Keerthi Gogineni3,4, Preeti Subhedar3,4, Kevin C Ward1,3, Jeffrey M Switchenko3,5, Joseph Lipscomb3,6, Jasmine Miller-Kleinhenz1, Mylin A Torres3,4, Jolinta Lin3,4, Lauren E McCullough1,3. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 2. Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah. 3. Winship Cancer Institute, Emory University, and. 4. Emory University School of Medicine, Atlanta Georgia; and. 5. Department of Biostatistics and Bioinformatics, and. 6. Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: Racial disparities in breast cancer mortality in the United States are well documented. Non-Hispanic Black (NHB) women are more likely to die of their disease than their non-Hispanic White (NHW) counterparts. The disparity is most pronounced among women diagnosed with prognostically favorable tumors, which may result in part from variations in their receipt of guideline care. In this study, we sought to estimate the effect of guideline-concordant care (GCC) on prognosis, and to evaluate whether receipt of GCC modified racial disparities in breast cancer mortality. PATIENTS AND METHODS: Using the Georgia Cancer Registry, we identified 2,784 NHB and 4,262 NHW women diagnosed with a stage I-III first primary breast cancer in the metropolitan Atlanta area, Georgia, between 2010 and 2014. Women were included if they received surgery and information on their breast tumor characteristics was available; all others were excluded. Receipt of recommended therapies (chemotherapy, radiotherapy, endocrine therapy, and anti-HER2 therapy) as indicated was considered GCC. We used Cox proportional hazards models to estimate the impact of receiving GCC on breast cancer mortality overall and by race, with multivariable adjusted hazard ratios (HRs). RESULTS: We found that NHB and NHW women were almost equally likely to receive GCC (65% vs 63%, respectively). Failure to receive GCC was associated with an increase in the hazard of breast cancer mortality (HR, 1.74; 95% CI, 1.37-2.20). However, racial disparities in breast cancer mortality persisted despite whether GCC was received (HRGCC: 2.17 [95% CI, 1.61-2.92]; HRnon-GCC: 1.81 [95% CI, 1.28-2.91] ). CONCLUSIONS: Although receipt of GCC is important for breast cancer outcomes, racial disparities in breast cancer mortality did not diminish with receipt of GCC; differences in mortality between Black and White patients persisted across the strata of GCC.
BACKGROUND: Racial disparities in breast cancer mortality in the United States are well documented. Non-Hispanic Black (NHB) women are more likely to die of their disease than their non-Hispanic White (NHW) counterparts. The disparity is most pronounced among women diagnosed with prognostically favorable tumors, which may result in part from variations in their receipt of guideline care. In this study, we sought to estimate the effect of guideline-concordant care (GCC) on prognosis, and to evaluate whether receipt of GCC modified racial disparities in breast cancer mortality. PATIENTS AND METHODS: Using the Georgia Cancer Registry, we identified 2,784 NHB and 4,262 NHW women diagnosed with a stage I-III first primary breast cancer in the metropolitan Atlanta area, Georgia, between 2010 and 2014. Women were included if they received surgery and information on their breast tumor characteristics was available; all others were excluded. Receipt of recommended therapies (chemotherapy, radiotherapy, endocrine therapy, and anti-HER2 therapy) as indicated was considered GCC. We used Cox proportional hazards models to estimate the impact of receiving GCC on breast cancer mortality overall and by race, with multivariable adjusted hazard ratios (HRs). RESULTS: We found that NHB and NHW women were almost equally likely to receive GCC (65% vs 63%, respectively). Failure to receive GCC was associated with an increase in the hazard of breast cancer mortality (HR, 1.74; 95% CI, 1.37-2.20). However, racial disparities in breast cancer mortality persisted despite whether GCC was received (HRGCC: 2.17 [95% CI, 1.61-2.92]; HRnon-GCC: 1.81 [95% CI, 1.28-2.91] ). CONCLUSIONS: Although receipt of GCC is important for breast cancer outcomes, racial disparities in breast cancer mortality did not diminish with receipt of GCC; differences in mortality between Black and White patients persisted across the strata of GCC.
Authors: Annette Wigertz; Johan Ahlgren; Marit Holmqvist; Tommy Fornander; Jan Adolfsson; Henrik Lindman; Leif Bergkvist; Mats Lambe Journal: Breast Cancer Res Treat Date: 2012-05 Impact factor: 4.872
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Authors: Richard J Bleicher; Karen Ruth; Elin R Sigurdson; J Robert Beck; Eric Ross; Yu-Ning Wong; Sameer A Patel; Marcia Boraas; Eric I Chang; Neal S Topham; Brian L Egleston Journal: JAMA Oncol Date: 2016-03 Impact factor: 31.777