SURVIVAL OF U.S. BLACK AND WHITE PATIENTS

Posted by James

Lower survival rates for black (African American) versus white patients with certain cancer, even within stage at diagnosis, has resulted in speculation that biologically more aggressive tumors in blacks may result in poorer prognosis and/or poorer response to cancer-directed treatment. A metaanalysis of studies of survival of U.S. black and white cancer patients who received comparable treatment for similar-stage cancer, however, showed limited evidence for black-white differences in sur­vival. For esophageal cancer, the single study involved only 47 black and 23 white patients diagnosed in 1968-1977 with local-regional stage squamous cell carcinoma who received radiotherapy; survival was lower for black than for white patients. Age-adjusted mortality rates and estimated incidence rates for esophageal cancer are about twice as high in U.S. blacks than whites. Incidence rates for adenocarcinoma are much higher in whites than blacks, while rates for squamous cell carcinoma in blacks exceed those in whites by a factor of three or more; incidence rates for squamous cell carcinoma have been declining slowly, while rates for adenocarcinoma have been increasing.

The U.S. National Cancer Institute’s Surveillance, Epidemiology, and End-Results (SEER) Program of high-quality cancer registries, established in 1973, provides data regarded as generally representative of the entire United States. The purpose of this study was to use SEER data to examine black-white differences in survival rates and risk of death among patients diagnosed with squamous cell carcinoma of the esophagus, controlling for stage at diagnosis, sociodemographic characteristics of patients, potential indicators of accuracy of staging, and receipt of cancer-directed surgery and radiotherapy. Surgery is regarded as the standard of care for localized-regional stage esophageal cancer; radiotherapy plus chemotherapy may replace surgery, but there is no consensus on treatment. SEER data on chemotherapy are incomplete, but results of clinical trials on preoperative chemotherapy have been inconsistent. discount drugs canda