Breast-cancer - Factors Associated With Stage At Diagnosis In Black-and-white Women
american-college; body size; national survey; Oncology; patient characteristics; positive axillary nodes; progesterone-receptor; racial-differences; self-examination; socioeconomic-status; united-states
Background: Numerous studies have reported differences in cancer staging at diagnosis and in survival between Black and White patients with breast cancer. Utilizing data obtained from the National Cancer Institute's (NCI's) Black/White Cancer Survival Study for the period 1985-1986, a new study is presented here that systematically examines multiple explanatory factors (e.g., lack of mammograms) associated with these cancer-staging differences. Purpose: We evaluated within a single study the relationship of selected demographic, lifestyle, antecedent medical experiences, and health care acces s factors to cancer staging at diagnosis in Black and White breast cancer patients. Methods: Data utilized in this population-based cohort study of 1222 eligible women (649 Black and 573 White) newly diagnosed for the period 1985-1986 with histologically confirmed primary breast cancer were obtained from the NCI's Black/White Cancer Survival Study. Sources of data included abstracts of hospital medical records, central review of histology slides by a study consultant pathologist, and patient interviews obtained from three metropolitan areas: Atlanta, New Orleans, and San Francisco-Oakland. Within each area, 70% of all Black incident cases were randomly selected, and a sample of White cases, frequency matched by age groups (20-49 years, 50-64 years, and 65-79 years), was selected for comparison. Stage of breast cancer at diagnosis was classified according to the international tumor-lymph node-metastases (TNM) system. Statistical models utilized in this study included the log-linear and polychotomous logistic regression with multiple predictor variables. Results: Factors associated with cancer staging were differentially expressed in Blacks and Whites. Indicators of access to health care, a lack of mammograms, and an increased body mass index significantly (P<.02) contributed to stage differences in Blacks, whereas income was marginally associated (P = .06) with stage for Whites only. Nuclear grade, having a breast examination by a physician, and a history of patient delay explained approximately 50% of the excess risk for stage III-IV Cancer versus stage I-II(N0) cancer among Blacks compared with Whites (odds ratio- reduction from 2.19 to 1.68). Conclusion: These findings suggest that no single factor or group of factors can explain more than half of the race-stage differences noted in this study with respect to Black and White breast cancer patients.
Hunter C P; Redmond C K; Chen V W; Austin D F; Greenberg R S; Correa P; Muss H B; Forman M R; Wesley M N; Blacklow R S; Kurman R J; Dignam J J; Edwards B K; Shapiro S
Journal of the National Cancer Institute
1993
1993-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1093/jnci/85.14.1129" target="_blank" rel="noreferrer noopener">10.1093/jnci/85.14.1129</a>
Racial-differences In Survival From Breast-cancer - Results Of The National-cancer-institute Black/white Cancer Survival Study
black-white differences; delay; estrogen; experience; General & Internal Medicine; project; race; socioeconomic-status; stage; women
Eley J W; Hill H A; Chen V W; Austin D F; Wesley M N; Muss H B; Greenberg R S; Coates R J; Correa P; Redmond C K; Hunter C P; Herman A A; Kurman R; Blacklow R; Shapiro S; Edwards B K
Jama-Journal of the American Medical Association
1994
1994-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1001/jama.272.12.947" target="_blank" rel="noreferrer noopener">10.1001/jama.272.12.947</a>
Bladder cancer - Race differences in extent of disease at diagnosis
bacillus-calmette-guerin; biologic implications; black-white; bladder cancer; cancer; carcinoma insitu; differences; grade; Oncology; race; registry; risk-factors; sociodemographic factors; stage; survival; transitional-cell neoplasms; urinary-bladder
BACKGROUND. Blacks are less likely than whites to develop bladder cancer; although once diagnosed, blacks experience poorer survival. This study sought to examine multiple biological and behavioral factors and their influence on extent of disease. METHODS. A population-based cohort of black bladder cancer patients and a random sample of frequency-matched white bladder cancer patients, stratified by age, gender, and race were identified through cancer registry systems in metropolitan Atlanta, New Orleans, and the San Francisco/Oakland area. Patients were ages 20-79 years at bladder cancer diagnosis from 1985-1987, and had no previous cancer history. Medical records were reviewed at initial diagnosis. Of the patients selected for study, a total of 77% of patients was interviewed. Grade, stage, and other variables (including age, socioeconomic status, symptom duration, and smoking history) were recorded. Extent of disease was modeled in 497 patients with urothelial carcinoma using logistic regression. RESULTS. Extent of disease at diagnosis was significantly greater in Blacks than in Whites. Older age group, higher tumor grade, larger tumors, and presence of carcinoma in situ were related to greater extent of disease in blacks and in whites. Large disparities between blacks and whites were found for socioeconomic status and source of care. Blacks had greater symptom duration and higher grade. Black women were more likely to have invasive disease than white women; this difference was not seen among men. Blacks in unskilled occupational categories, perhaps reflecting socioeconomic factors, were at much higher risk for muscle invasion than whites. CONCLUSIONS. While specific relationships between variables were noted, an overall pattern defining black and white differences in stage did not emerge. Future studies should examine the basis upon which occupation and life style factors operate by using biochemical and molecular methods to study the genetic factors involved. Published 2000 by the American Cancer Society.*.
Prout G R; Wesley M N; Greenberg R S; Chen V W; Brown C C; Miller A W; Weinstein R S; Robboy S J; Haynes M A; Blacklow R S; Edwards B K
Cancer
2000
2000-09
Journal Article
<a href="http://doi.org/10.1002/1097-0142(20000915)89:6%3C1349::aid-cncr20%3E3.0.co;2-d" target="_blank" rel="noreferrer noopener">10.1002/1097-0142(20000915)89:6%3C1349::aid-cncr20%3E3.0.co;2-d</a>