Racial differences in breast cancer survival remain large, unchanged

Image: PD 

1. Racial differences in breast cancer survival have not significantly changed between black and white women between 1991 and 2005. 

2. Disparities in survival appear to be related to presentation characteristics and comorbid conditions at the time of diagnosis rather than breast cancer treatment. 

Evidence Rating Level: 2 (Good) 

Study Rundown: For decades, researchers have been cognizant of the role of racial differences in breast cancer survival. This current study aimed to identify the cause of this survival difference in black and white women with clinically similar presentations and what role, if any, does treatment differences explain this disparity. The study found a 12.9% absolute difference in 5-year survival rates among black women (55.9%) diagnosed with breast cancer compared to white women (68.6%) matched with similar demographics, presentations, and treatments. Lower survival rates were attributed to poorer health status, more advanced disease, and more comorbid conditions in black women at the time of diagnosis. Treatment differences accounted for a smaller difference in 5-year survival. Decreasing these disparities may be attainable by improving primary care screening, decreasing comorbid conditions, and late-stage diagnosis in black women. A major strength of this study was the large cohort with very closely matched controls. The study was limited by an inability to perform chart reviews to verify treatments. 

Click to read the study published today in JAMA

Click to read an accompanying editorial published today in JAMA

Relevant Reading: Racial and ethnic differences in breast cancer survival: how much is explained by screening, tumor severity, biology, treatment, comorbidities, and demographics?

In-Depth [retrospective matched cohort study]: This study compared 5-year survival between 7375 black women and 7375 matched white women age 65-years and older with newly diagnosed breast cancer between 1991 to 2005. The absolute difference in 5-year survival was 12.9% (blacks 55.9%, whites 68.6%, p < 0.001). Black women still had lower 5-year survival rates after matching for presentation characteristics and treatments for breast cancer (4.4% and 3.6% respectively, p < 0.001). In addition, fewer black women received treatment for cancer (12.6% blacks vs 5.9% whites), and average time to treatment was longer (29.2 days for blacks vs 22.5 days for whites). However, differences in treatment only accounted for 0.81% of the 12.9% difference in survival. Larger differences in primary care screening and utilization were observed including fewer primary care visits (blacks 80.5%, whites 87%, p < 0.001) and lower utilization of breast cancer screening (blacks 23.5%, whites 31%, p < 0.001).

By Gayatri Boddupalli and Brittany Hasty

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