Journal
BREAST CANCER RESEARCH AND TREATMENT
Volume 173, Issue 1, Pages 225-237Publisher
SPRINGER
DOI: 10.1007/s10549-018-4956-y
Keywords
Metastatic breast cancer; Racial disparity; Breast cancer prognosis; Age group
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Funding
- Ministry of Science and Technology of China (National Key R&D Program of China) [MOST2016YFC0900300]
- National Natural Science Foundation of China [81572583, 81672601, 81602311]
- Shanghai Committee of Science and Technology Funds [15410724000]
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PurposePopulation-based estimates of racial disparities in metastatic breast cancer are lacking. We quantified the contributions of demographic, socioeconomic, tumor, and metastatic characteristics to racial differences in metastatic breast cancer and characterized the most disproportional subgroup.MethodsPatients diagnosed with metastatic breast cancer between 2010 and 2014 were identified using the Surveillance, Epidemiology, and End Results database. A multivariable Cox proportional hazards model was used to adjust each set of variables. The excess relative risk of cancer-specific and all-cause death in non-Hispanic black (NHB) versus non-Hispanic white women diagnosed with metastatic breast cancer was expressed as a percentage and was stratified by the age at diagnosis.ResultsWe identified 13,066 female patients. NHB women exhibited substantially higher morbidity and mortality than women of other races/ethnicities. The greatest excess mortality risk for NHB women was observed in the young-onset group (18-49years; hazard ratio: 1.57), followed by the middle-age group (50-64years; hazard ratio: 1.42); the trend was not significant among the elderly group. Socioeconomic factors stably explained one-half of the excess risk, whereas the contribution of tumor characteristics obviously decreased with age (18-49years, 40.7%; 50-64years, 33.9%), and the metastatic pattern accounted for approximately one-tenth of the excess risk. Additionally, the disproportional death burden of NHB women persisted in less aggressive subgroups.ConclusionsBy providing a comprehensive assessment of racial differences in the incidence and outcomes of patients with metastatic breast cancer, we urge the implementation of targeted preventive efforts in both the public health and clinical arenas.
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