Association of Race and Breast Cancer Stage

Posted by James

INTRODUCTION

Breast cancer is the most common cancer among women in the United States. It is diagnosed in approximately 240,000 women and kills an estimated 40,000 women each year. It is suspected that as the baby boomer population ages the absolute number of women diagnosed will rise by one-third over the next 20 years, increasing the number to 320,000 females diagnosed annually. The peak age of diagnosis is 45-65 years, with approximately 77% occurring in females age >50. Though screening recommendations vary among organizations, American Cancer Society guidelines for breast cancer screening consist of optional monthly self-breast exams starting at age 20, and clinical breast exams every 2-3 years until the age of 40, then annually. Yearly mammograms are initiated at the age of 40 as well, or earlier, based on preexisting risk factors. Multiple risk factors for breast cancer have been identified including: increasing age, presence in a first-degree relative, early menarche, nulliparity, delayed first pregnancy, prior personal history of breast cancer, endometrial cancer, abnormal breast biopsy, exogenous estrogen use, radiation exposure, geographical influence, diet and white race.

Breast cancer has the second highest death rate among cancers for both African-American and Caucasian women nationwide. The overall lifetime risk of being diagnosed with breast cancer is 10.14% for African-American women and 13.83% for Caucasian women; however, approximately 31/100,000 African-American women die annually compared to 27/100,000 white women. From this data, it is conclusive that although Caucasian women are diagnosed more frequently, African-American women have a higher mortality rate.

In previous studies, it has been found that African-American women are more likely to present with advanced-stage breast cancer at diagnosis and, consequently, a poorer prognosis. The largest most comprehensive study of its kind to evaluate the relationship among race, breast cancer stage, treatment and survival was performed by Li et al. They con­ducted a cohort study comprised of 124,934 women diagnosed with breast cancer from the Surveillance, Epidemiology and End Results Program (SEER). In their study, African Americans were significantly more likely to be diagnosed with American Joint Committee on Cancer (AJCC) stages 2, 3 and 4, and were significantly less likely to be in stage 1 compared to Caucasian Americans. They also found African-American women were 40% more likely to undergo initial treatments that were below national standards. One important limitation of this study is that they were unable to control for any assessment of socioeconomic status.

To investigate the influence of socioeconomic and cultural factors on racial differences in breast cancer stage, Lannin et al. conducted a case-control study of 540 women from eastern North Carolina. They found that socioeconomic and cultural factors explain some but not all of the racial variation found in late-stage breast cancer. Similarly, when Bradley et al. linked Medicaid and SEER data, they found similar results. Current literature suggests thatsocioeconomic factors, mammography usage, insurance status and cultural beliefs are all possible reasons to explain some racial variation in breast cancer stage distribution. Viagra Super Active

The purpose of our study was to investigate the influence of race on breast cancer stage at diagnosis, also taking into consideration additional confounding variables not previously considered, including topography, morphology and laterality.