Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors

Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors

This is a bit thick in the science of things but the point , as I discuss on the book web page about cancer in minorities , is that there are disparities in survival based on racial lines. We are now seeing  very large scale statistical work which is narrowing down EXCATLY WHAT  disparities and among who. Next will come the why and the targeted screening and therapy This is  a good thing Dr.  Ryan

  1. Erica T. Warner,
  2. Rulla M. Tamimi,
  3. Melissa E. Hughes,
  4. Rebecca A. Ottesen,
  5. Yu-Ning Wong,
  6. Stephen B. Edge,
  7. Richard L. Theriault,
  8. Douglas W. Blayney,
  9. Joyce C. Niland,
  10. Eric P. Winer,
  11. Jane C. Weeks and
  12. Ann H. Partridge

+ Author Affiliations

  1. Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women’s Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.

+ Author Notes

  • Deceased.

  1. Corresponding author: Erica T. Warner, ScD, MPH, Department of Epidemiology, Harvard School of Public Health, 181 Longwood Ave, Room 452, Boston, MA 02115; e-mail: ewarner@hsph.harvard.edu.


Purpose To evaluate the relationship between race/ethnicity and breast cancer–specific survival according to subtype and explore mediating factors.

Patients and Methods Participants were women presenting with stage I to III breast cancer between January 2000 and December 2007 at National Comprehensive Cancer Network centers with survival follow-up through December 2009. Cox proportional hazards regression was used to compare breast cancer–specific survival among Asians (n = 533), Hispanics (n = 1,122), and blacks (n = 1,345) with that among whites (n = 14,268), overall and stratified by subtype (luminal A like, luminal B like, human epidermal growth factor receptor 2 type, and triple negative). Model estimates were used to derive mediation proportion and 95% CI for selected risk factors.

Results In multivariable adjusted models, overall, blacks had 21% higher risk of breast cancer–specific death (hazard ratio [HR], 1.21; 95% CI, 1.00 to 1.45). For estrogen receptor–positive tumors, black and white survival differences were greatest within 2 years of diagnosis (years 0 to 2: HR, 2.65; 95% CI, 1.34 to 5.24; year 2 to end of follow-up: HR, 1.50; 95% CI, 1.12 to 2.00). Blacks were 76% and 56% more likely to die as a result of luminal A–like and luminal B–like tumors, respectively. No disparities were observed for triple-negative or human epidermal growth factor receptor 2–type tumors. Asians and Hispanics were less likely to die as a result of breast cancer compared with whites (Asians: HR, 0.56; 95% CI, 0.37 to 0.85; Hispanics: HR, 0.74; 95% CI, 0.58 to 0.95). For blacks, tumor characteristics and stage at diagnosis were significant disparity mediators. Body mass index was an important mediator for blacks and Asians.

Conclusion Racial disparities in breast cancer survival vary by tumor subtype. Interventions are needed to reduce disparities, particularly in the first 2 years after diagnosis among black women with estrogen receptor–positive tumors.


  • Supported by the National Cancer Institute (NCI) Specialized Program of Research Excellence in Breast Cancer Grant No. NIH P50 CA089393; by the National Comprehensive Cancer Network; and by NCI Grants No. 5T32CA009001-36 and K01CA188075-01 (E.T.W.).


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