© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 20, 1690-1691,
October 18, 2000
© 2000 Oxford University Press
CORRESPONDENCE |
Re: Race and Differences in Breast Cancer Survival in a Managed Care Population
Affiliation of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.
Correspondence to: Robert Millikan, D.V.M., Ph.D., CB #7400, Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599-7400 (e-mail: bob_millikan{at}unc.edu).
Yood et al. (1) reported that differences in survival between African-American and white breast cancer patients were negligible after adjustment for age, income, marital status, and stage at diagnosis. The authors studied enrollees in a managed care program where African-American and white women had equal access to health care and similar surgical treatment for breast cancer (2).
We determined whether racial differences exist in the surgical treatment for breast cancer within the general population and whether this relationship is altered by adjustment for sociodemographic variables. We used data collected from The Carolina Breast Cancer Study, a population-based case–control study in North Carolina (3). The study was approved by the Institutional Review Board at the University of North Carolina School of Medicine. Multiple logistic regression was used to estimate odds ratios for the type of surgery received: mastectomy (including simple mastectomy, modified radical mastectomy, and total mastectomy) versus breast-conserving surgery (lumpectomy, segmental mastectomy, partial mastectomy, and quandrantectomy).
The results of our analysis are presented in Table 1
. Taken singly without adjustment for other predictors, the strongest predictors of receiving a mastectomy were later stage at diagnosis (based upon the American Joint Committee on Cancer (AJCC) TNM staging system), lower educational level, lower income, residence in a rural area or small town, and African-American race. After mutual adjustment for all predictors, the strongest predictors were later stage at diagnosis, lower educational level, and residence in a rural area or small town. African-American women were more likely to undergo mastectomy than white women [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.1–2.0], but the association disappeared after mutual adjustment for all predictors (OR = 1.1; 95% CI = 0.8–1.7).
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Our results are similar to those of Muss et al. (4). Muss et al. found that fewer African-American women underwent breast-conserving surgery compared with white women (4); however, in multivariate analyses, racial differences were no longer statistically significant, and higher educational level and metropolitan area of residence remained strong predictors of undergoing breast-conserving surgery. Women with lower education and those who reside in rural areas or small towns may not be aware of the option of breast-conserving surgery. Further research is needed to identify predictors of the type of breast cancer treatment received among women with differing sociodemographic characteristics and the effects of such factors on long-term survival (5,6).
NOTES
Editor's note: Yood et al. declined to respond to the correspondence of Dunmore et al.
REFERENCES
1
Yood MU, Johnson CC, Blunt A, Abrams J, Wolman E, McCarthy BD, et al. Race and differences in breast cancer survival in a managed care population. J Natl Cancer Inst 1999;91:1487–91.
2 Velanovich V, Yood MU, Bawle U, Nathanson SD, Strand VF, Talpos GB, et al. Racial differences in the presentation and surgical management of breast cancer. Surgery 1999;125:375–9.[Web of Science][Medline]cancerlit;99232173
3 Newman B, Moorman PG, Millikan R, Qaqish BF, Geradts J, Aldrich TE, et al. The Carolina Breast Cancer Study: integrating population-based epidemiology and molecular biology. Breast Cancer Res Treat 1995;35:51– 60.[CrossRef][Web of Science][Medline]cancerlit;95337395
4 Muss HB, Hunter CP, Wesley M, Correa P, Chen VW, Greenberg RS, 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. Cancer 1992;70:2460–7.[CrossRef][Web of Science][Medline]cancerlit;93046009
5 Diehr P, Yergan J, Chu J, Feigl P, Glaefke G, Moe R, et al. Treatment modality and quality differences for black and white breast-cancer patients treated in community hospitals. Med Care 1989;27:942–58.[CrossRef][Web of Science][Medline]cancerlit;90013445
6 Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology 1997;8:621–8.[CrossRef][Web of Science][Medline]
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