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CA: A Cancer Journal for Clinicians, Vol 50, Issue 1 50-64, Copyright © 2000 by American Cancer Society
J. J. Dignam
This review explores factors potentially contributing to the disparity in
survival after breast cancer between African-American and Caucasian women
in the United States. A number of factors have been implicated as the cause
of poorer survival for black women, including clinical and pathologic
features of the disease that are indicative of poor prognosis, economic
resource inequities, and differences in treatment access and efficacy. The
latter is explored in detail using data from the National Surgical Adjuvant
Breast and Bowel Project (NSABP), a nationwide multicenter clinical trials
group for breast and colorectal cancers. Key studies into the disparity in
breast cancer survival are reviewed according to proposed principal
determinants of poorer outcome for black women. Results among black and
white women participating in several randomized NSABP clinical trials are
also presented. Primary endpoints in those studies were clinical and
pathologic disease characteristics at study entry, time to disease
progression or new cancers, and total survival time after breast cancer
diagnosis and treatment. In most studies reported in the literature, the
primary explanatory factor alone, such as stage of disease at diagnosis,
did not fully account for differences in outcome between groups; when
additional factors were taken into account, however, prognoses became more
similar. Results from the NSABP clinical trials similarly indicated that
when stage of disease and treatment were comparable, outcomes for blacks
did not differ markedly from those of whites. In summary, black women,
diagnosed at comparable disease stage as white women and treated
appropriately, tend to experience similar breast cancer prognoses and
survival. However, important clinical and pathologic disease
characteristics may continue to place certain women at increased risk of
poorer outcome, and warrant continued study. The opportunity for increased
clinical trial participation by black women is encouraged.
ARTICLES
Differences in breast cancer prognosis among African-American and Caucasian women
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA, USA.
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