Racial/Ethnic Disparity in Survival of Primary Invasive Breast Cancer for Patients Undergoing Breast Conserving Surgery followed by Radiation Open Access

Figueroa, Erica (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/79407x37q?locale=en


Background: The aim of this study is to compare breast cancer survival between Hispanic whites and non-Hispanic whites in order to better understand the risk factors for each group. The study will focus on women who received both radiation and breast conserving surgery, controlling for factors that are known to have an effect on survival. Previous studies have identified racial disparities in breast cancer survival among whites, blacks, and Hispanic women but have not focused on comparing the different Hispanic racial groups.

Methods: Data for this study was obtained from the Surveillance, Epidemiology, and End Results (SEER) Program for cases of primary malignant breast cancer diagnosed from 2000 to 2010, with a localized or regional disease stage. The study participants all received breast conserving surgery followed by beam radiation. Unadjusted Kaplan-Meier survival curves and crude 5 and 10-year relative survival estimates were used to compare survival between the racial subgroups. A multivariable Cox proportional hazards model was used to calculate hazard ratios, controlling for age and marital status at diagnosis, tumor grade, disease stage, and hormone receptor status.

Results: The final study population included 142,374 cases: with 12,665 Hispanic whites and 129,709, non-Hispanic whites. Unadjusted Kaplan-Meier survival curves and adjusted Cox-regression model estimates for 5 and 10-year analyses showed better survival for non-Hispanic whites versus Hispanic whites. The cox multivariable analyses showed that Hispanic whites had an increased risk of death from breast cancer in both the 5 and 10-year analyses. For the 5-year stratified Cox-regression model, Hispanic whites had an increased risk of 12% (HR=1.12; 95% CI: 1.01-1.25). The 10-year analysis showed a lower risk of death for Hispanic whites, but it was still higher compared to non-Hispanic whites, 10% (HR=1.10; 95% CI: 1.00-1.20).

Conclusions: There are still breast cancer survival disparities that exist between Hispanic white and non-Hispanic white women even after controlling for several risk factors. Hispanic white women continue to have an increased risk of death that is likely due to more behavioral and socioeconomic risk factors. Further research is needed to collect data on these factors that can be modified in order to increase breast cancer survival rates.

Table of Contents

Background. 1

Introduction. 1

BCS with Radiation as a Standard Treatment. 2

Post-Surgical Radiation Therapy. 3

Breast Conserving Surgery. 6

Tumor Stage. 7

Tumor Characteristics. 8

Physician Communication. 9

Socioeconomic Status. 10

Methods. 11

Study Population. 11

Covariates. 12

Survival and Censoring Time. 13

Statistical Analyses. 14

Results. 15

Treatment and Demographic Characteristics. 15

Clinical Characteristics. 16

Survival. 17

Discussion. 19

Strengths and Limitations. 21

Future Directions. 23

References. 25

Figures and Tables. 29

Figure 1. 29

Figure 2. 29

Table 1. 30

Table 2. 30

Table 3. 32

Table 4. 33

Table 5. 34

Table 6. 35

Table 7. 36

Table 8. 37

Table 9. 37

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