Although African-American women have worse breast cancer survival than White women at all stages of the disease, the extent of the difference is greatest among women with more advanced disease. These results were published in the journal Cancer.
Cancer incidence and survival in the U.S. continues to vary by race and ethnicity. In the case of breast cancer, African-American women are less likely than White women to be diagnosed with the disease but more likely to die from it. Even among women with the same stage of breast cancer, African-American women have worse survival.
Survival differences among women with the same stage of breast cancer may be explained by factors such as differential access to healthcare, differences in gene expression or tumor biology, or within-stage differences in tumor size or number of involved lymph nodes.
To explore whether differences in tumor size or number of involved lymph nodes among women with the same stage of disease explains disparities in breast cancer survival, researchers conducted a study among more than 256,000 women with Stage I to Stage IIIA breast cancer. Roughly 9% of the study participants were African American.
- Among women with node-negative breast cancer, average tumor size was larger among African-American women than among White women.
- Among women with similar-sized tumors, African-American women were more likely to have involved lymph nodes than White women.
- After accounting for tumor size and number of involved lymph nodes, African-American women still had worse survival than White women. Overall, the risk of death was roughly 39% higher in African-American women than in White women.
- The survival difference between African-American and White women was apparent across all stages of breast cancer but was especially large for women with more advanced cancer. Among women with Stage I breast cancer, the risk of death was 26% higher among African-American women than among White women. In contrast, among women with Stage IIIA breast cancer, the risk of death was 64% higher among African-American women than among White women.
This study suggests that within-stage differences in tumor size or number of involved lymph nodes do not explain differences in breast cancer survival between African-American and White women. Furthermore, the researchers point out that interventions to reduce racial disparities in breast cancer survival will be particularly important for women with advanced disease.
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Reference: McBride R, Hershman D, Tsai W-Y, Jacobson JS, Grann V, Neugut AI. Within-stage racial differences in tumor size and number of positive lymph nodes in women with breast cancer. Cancer[early online publication]. August 13, 2007.
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