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. 2008 Feb 25:6:26.
doi: 10.1186/1477-7819-6-26.

Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for Black women after breast cancer treatment

Steve H Kim  1 , Jeanne Ferrante, Bok Ran Won, Meera Hameed
Affiliations

Barriers to adequate follow-up during adjuvant therapy may be important factors in the worse outcome for Black women after breast cancer treatment

Steve H Kim et al. World J Surg Oncol. .

Abstract

Introduction: Black women appear to have worse outcome after diagnosis and treatment of breast cancer. It is still unclear if this is because Black race is more often associated with known negative prognostic indicators or if it is an independent prognostic factor. To study this, we analyzed a patient cohort from an urban university medical center where these women made up the majority of the patient population.

Methods: We used retrospective analysis of a prospectively collected database of breast cancer patients seen from May 1999 to June 2006. Time to recurrence and survival were analyzed using the Kaplan-Meier method, with statistical analysis by chi-square, log rank testing, and the Cox regression model.

Results: 265 female patients were diagnosed with breast cancer during the time period. Fifty patients (19%) had pure DCIS and 215 patients (81%) had invasive disease. Racial and ethnic composition of the entire cohort was as follows: Black (N = 150, 56.6%), Hispanic (N = 83, 31.3%), Caucasian (N = 26, 9.8%), Asian (N = 4, 1.5%), and Arabic (N = 2, 0.8%). For patients with invasive disease, independent predictors of poor disease-free survival included tumor size, node-positivity, incompletion of adjuvant therapy, and Black race. Tumor size, node-positivity, and Black race were independently associated with disease-specific overall survival.

Conclusion: Worse outcome among Black women appears to be independent of the usual predictors of survival. Further investigation is necessary to identify the cause of this survival disparity. Barriers to completion of standard post-operative treatment regimens may be especially important in this regard.

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Figures

Figure 1
Figure 1
Disease-free survival was significantly worse in Black women compared to those of other races (p < .01).
Figure 2
Figure 2
Refusal or failure to complete adjuvant therapy regimens was associated with significantly worse rates of disease-free survival (p < .001).
Figure 3
Figure 3
Black race was a significant predictor of disease-specific survival on both univariate (p < .01) and multivariate analyses.
See this image and copyright information in PMC

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