Geographical influence on racial disparity in breast cancer presentation in the United States

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It has been shown that breast cancer presentation varies between racial groups nationwide. Several studies have suggested that this is more a function of geographic rather than true racial disparity. The current study was undertaken to examine racial disparity in breast cancer presentation and to determine whether such disparity continues to be seen once geographic factors are taken into account. Breast cancer data were reviewed for all programs reporting to the American College of Surgeons Commission on Cancer National Cancer Database (NCDB) between 2000 and 2007, inclusive. These data were readily available online. Variables reviewed were: stage at the time of presentation; race; histology; and geographic location within the United States. Four broad regions of the country were chosen, corresponding to the U.S. Census Regions: Northeast, South, Midwest, and West. Patient data were classified as either "early" (stages 0, I, and II) or "late" (stages III and IV) at the time of presentation. A total of 1,388,186 patients were reported during the study period; 1,132,128 white and 256,058 nonwhite. There was a statistically significant difference in presentation between the two racial cohorts; a significantly higher percentage of whites presented with "early" disease (88.8%) when compared with nonwhites (83.8%). This statistically significant difference persisted even when the data were corrected for geographic location within the United States. There is a racial disparity with regard to breast cancer presentation throughout the United States which seems to be independent of geographic location. Nonwhites in all geographic regions present with later-stage disease than whites.     

Geographic Differences in Treatment of Early Stage Breast Cancer

The objective of this study was to describe recent time and geographic variations in breast cancer treatment while controlling for patient age, race, and ethnic group. Treatment data for women diagnosed with localized breast cancer from nine defined geographic areas of the United States from 1983 through 1992 were analyzed. Of 80,887 subjects, 33.9% were treated with lumpectomy from 1983 to 1992. The proportion of women treated with lumpectomy varied greatly according to geographic area, ranging from overall percentages of 19.0% in Iowa to 41.4% in Connecticut, but increased in all sites during the time period under study. Women less than 50 years and more than age 80 years and older were most likely to have lumpectomy, while Asian/Pacific islander women were significantly less likely compared to Caucasian women. Rates for African American and Hispanic women were not significantly different than those for Caucasian women. Although consensus conferences and randomized clinical trials have indicated lumpectomy is appropriate therapy for the majority of women diagnosed with early stage breast cancer, large geographic differences in rates have persisted over time. These differences were not explained by underlying differences in age or race distributions in the geographic areas included in this study. ▪     

Gender and geographic influence on the racial disparity in bladder cancer mortality in the US

BACKGROUND: In 2005, there were an estimated 63,210 new cases of bladder cancer and 13,180 related deaths in the US. African Americans reportedly have a lower incidence of bladder cancer, but a higher mortality. The objective of this study was to evaluate the gender and geographic differences in bladder cancer survival between Caucasians and African Americans to better understand the racial disparity in bladder cancer survival. STUDY DESIGN: Surveillance Epidemiology and End Results Program (SEER) data were used to evaluate racial differences in bladder cancer survival from 1973 to 1999. Bivariate and multivariate Cox proportional hazard models were performed to determine the relationship between race and survival, adjusting for cancer stage and grade, marital status, region of country, treatment received, and the interaction between race and region. RESULTS: African Americans were diagnosed with higher grade (p < 0.001) and higher stage (p < 0.001) tumors, compared with Caucasians. In the multivariable model, African-American race was an independent predictor of poor survival, adjusting for age, marital status, region of the country, stage, grade, treatment received, and interaction between race and region. Surprisingly, African Americans diagnosed in the Atlanta metropolitan area had a substantially worse survival. CONCLUSIONS: African Americans were diagnosed with more aggressive and more advanced tumors. Adjusted multivariable models demonstrated a survival advantage for Caucasians, with African-American race being an independent predictor of poor survival, especially when diagnosed in the Atlanta metropolitan area. Racial disparity continues to exist in bladder cancer presentation and survival in the US.     

Lack of seasonal variation in idiopathic talipes equinovarus

BACKGROUND: One proposed etiology of idiopathic talipes equinovarus is an in utero enterovirus infection. Enterovirus infections demonstrate seasonal variation in temperate climates. METHODS: We collected data on 1202 children with idiopathic talipes equinovarus born in the Northeastern United States, Midwestern United States, and the United Kingdom to investigate a seasonal variation in this congenital deformity. Birth date, gestational age at the time of delivery, gender, race, and laterality were tabulated and subjected to univariate and bivariate analyses. RESULTS: There were 774 boys and 428 girls with idiopathic talipes equinovarus. The birth location was the United Kingdom (458 children), the Midwestern United States (426 children), and the Northeastern United States (318 children). No significant differences were detected among the geographic groups with respect to gender, race, or laterality, and no variation in month of birth or month of conception was noted. CONCLUSIONS: This study does not support an in utero enterovirus infection as an etiology of idiopathic talipes equinovarus in industrialized populations.     

The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry

BACKGROUND: Women diagnosed with breast carcinoma in situ are at increased risk for developing a contralateral breast cancer. The magnitude of this risk and the relationship between this risk and age, time since diagnosis, histologic subtype, and treatment for the first breast cancer is continuing to be defined. METHODS: The risk of developing a contralateral breast cancer is examined among 4198 women diagnosed with breast carcinoma in situ and reported to the Connecticut Tumor Registry (CTR) between January 1, 1975 and March 14, 1998 using Kaplan-Meier estimation. A Cox proportional hazards model is used to assess the effect of surgical treatment, radiation therapy, age at diagnosis, race, histology, marital status, anatomic location within the breast, and time since diagnosis upon this risk. RESULTS: The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a ductal breast carcinoma in situ (DCIS) were 4.3% (95% confidence interval, 3.6-5.0%) and 6.8% (95% confidence interval, 5.5-8.2%), respectively. These risks are 3.35 times greater than those for women without a history of breast cancer but are similar to those for women diagnosed with non-metastatic invasive ductal carcinomas of the breast. The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a lobular breast carcinoma in situ (LCIS) were 11.9% (95% confidence interval, 9.5-14.3%) and 13.9% (95% confidence interval, 11.0-16.8%), respectively. CONCLUSIONS: Women diagnosed with LCIS were 2.6 (95% confidence interval, 2.0-3.4%) times more likely than women with DCIS to be diagnosed with a contralateral breast cancer within the first six months of the first breast primary. The risk of developing a contralateral breast cancer more than 6 months after the initial breast cancer was independent of surgical or radiation therapy, time since diagnosis, age at diagnosis, histology, race, marital status, or anatomic location of the cancer within the breast.     

Racial Differences in Breast Cancer Survival in Iowa

Abstract: The purpose of this study was to determine the effects of race on breast cancer survival, while controlling for the effects of patient age and stage at diagnosis. Subjects were 35,594 women diagnosed with primary breast cancer in Iowa from 1973 through early 1993. Data on subjects were provided from the State Health Registry of Iowa's Surveillance, Epidemiology, and End Result program, a population-based tumor registry. To determine if race was a significant predictor of survival, independent of patient age and stage at diagnosis, Cox's proportional hazards multiple regression analyses were used to estimate relative risk of death between races. Separate analyses were conducted for outcomes of breast cancer deaths and deaths from all cancers. Results of univariate analyses indicated African-American women had significantly poorer survival from breast cancer. However, after controlling for patient age and stage at diagnosis, race was not a significant independent predictor of survival. African-American women were 1.18 times as likely to die from breast cancer as Caucasian women (95% confidence interval: 0.94, 1.50). Results were similar for all cancer mortality. African-American women had poorer survival from breast cancer than Caucasian women, apparently due to breast cancer diagnosis at significantly younger ages and more advanced stage. These results indicate that public health measures aimed at earlier diagnosis in African-Americans might produce success in reducing racial differences in survival.     

Primary tumor location impacts breast cancer survival

BACKGROUND: The prognostic significance of tumor location in breast cancer remains unclear. To better understand this relationship, we evaluated the Department of Defense tumor registry. METHODS: Patients with infiltrating ductal adenocarcinoma or lobular carcinoma over a 10-year period were identified and analyzed. RESULTS: Of the 13,984 tumors, 7,871 (58%) originated from the upper-outer quadrant or axillary tail, whereas the remainder were found at the nipple complex (9%), upper-inner quadrant (14%), lower-inner quadrant (9%), and lower-outer quadrant (10%). Univariate analysis of cancer-specific survival revealed a significant difference based on location of the primary breast cancer. Upper-outer quadrant lesions were associated with an independent contribution toward a survival benefit. CONCLUSIONS: Upper-outer quadrant breast cancers have a more favorable survival advantage when compared with tumors in other locations. Factors that negatively impacted survival included high-grade tumors, advanced stage, and race.     

Factors influencing aggressive therapy for bladder cancer: an analysis of data from the SEER program

PURPOSE: We examined the association of various demographic, geographic and disease related factors, and the use of aggressive therapy defined as radical cystectomy or radiation therapy for bladder cancer. We also examined the correlation between these factors and disease specific survival such aggressive therapy. MATERIALS AND METHODS: Data from the Surveillance, Epidemiology and End Results (SEER) program public use files from 1992 to 1999 were used to analyze the demographic and disease related variables of patient age, sex, race, reporting SEER site/geographic region, disease stage, number of lymph nodes examined and number of positive lymph nodes. Cox proportional hazards model analysis was used to test for associations with disease specific survival and logistic regression was used to test the predictors of aggressive therapy. RESULTS: In multivariate models age, SEER site and disease stage were predictors of radical cystectomy while race, age, sex, SEER site and disease stage were significant factors predicting likelihood of radiation therapy. Disease stage and number of nodes examined were significantly associated with survival after radical cystectomy, while age, sex, SEER site and stage significantly affected survival after radiation therapy. CONCLUSIONS: Demographic, geographic and disease related characteristics of the patient population can significantly affect treatment choice in patients with bladder cancer. Disease specific survival after radical cystectomy appears to be influenced only by disease related factors (stage and extent of lymphadenectomy) compared to radiation therapy, where survival is influenced by nondisease related factors such as age, sex and SEER site. A significant number of patients who are older or live in certain geographic areas who are being denied aggressive therapy for bladder cancer would benefit from such therapy.     

Adjuvant therapies for very young women with early stage breast cancer

Approximately 16,000-19,000 women aged ≤ 45 are diagnosed annually with breast cancer in the United States and thousands more are diagnosed worldwide. Compared to older women, young women are more likely to have cancers with aggressive tumor biology and present with higher stage disease, both of which likely lead to their worse outcomes. We review the available evidence for adjuvant systemic therapy as well as treatment considerations for younger women with breast cancer. Although we have begun to appreciate the issues that younger women with breast cancer face, we need a better understanding of how we can optimally prevent disease recurrence while carefully considering their unique physical and emotional needs with regard to diagnosis, treatment, and survivorship.     

Increasing mastectomy rates among all age groups for early stage breast cancer: a 10-year study of surgical choice

First-line surgical options for early stage breast cancer and ductal carcinoma in situ include breast conserving surgery or mastectomy. We analyzed factors that influence the receipt of mastectomy and resultant trends over time. Registry analysis was carried out for 21,869 women who underwent up-front surgical treatment for stage 0, I or II breast cancer between 1998 and 2007 using data from the Kentucky Cancer Registry. We examined the trend of treatment over time and assessed the probability of receiving mastectomy using multivariate logistic regression. Overall, 54.5% of women received breast conservation and 45.5% received mastectomy over a 10-year period (annual BCS rate range: 46.9-61.2%). The overall mastectomy rate substantially decreased from 53.1% in 1998 to 38.8% in 2005 (p < 0.0001), but then increased to 45% in 2007 (p < 0.001). Between 2005 and 2007, the increase in mastectomies in the age groups of <50 years, 50-69 years, and ≥ 70 years was 7.5% (p = 0.0351), 4.9% (p = 0.0132) and, 8.0% (p = 0.0283), respectively. On multivariate analysis, the rate of receiving mastectomy was drastically higher for women with stage I or II (versus in situ) disease and moderate or poorly differentiated (versus well differentiated) histology. The rate was modestly higher for uninsured and government-insured (versus privately insured) patients, patients older than 70 years (versus younger), rural (versus urban) location, receptor negative (versus receptor positive) disease, and unusual histologies (versus ductal and lobular histology). There was no statistically significant difference in surgical choice with regard to race. Determinants of mastectomy for in situ and early stage breast cancer include stage, histology, age, insurance status, county of residence, receptor status. The rate of mastectomy declined until 2005 and is now increasing across all age groups, especially for women < 50 years and ≥ 70 years.     

An analysis of immediate postmastectomy breast reconstruction frequency using the surveillance, epidemiology, and end results database

Mastectomy is used to treat one third of the nearly 180,000 women diagnosed with breast cancer in the United States annually. In this study, we use population-level data from multiple years of the Surveillance, Epidemiology, End Results (SEER) database to further define patient, tumor, and geographic characteristics associated with immediate and early-delayed breast reconstruction. Population level de-identified data for the years 1998 to 2002 were extracted from the National Cancer Institute's (NCI) SEER cancer database. All female patients who were treated with mastectomy for a diagnosis of ductal and/or lobular breast cancer (including Paget disease) were included. The primary end point of interest was odds of reconstruction. Multivariate analysis was performed to control for patient demographic and oncologic characteristics. A total of 52,249 patients met the inclusion criteria. Reconstruction was performed in 8,446 patients (16.2%). Odds of reconstruction varied by region from 0.60 (Seattle) to 2.81 (Atlanta). African Americans were noted to have a significantly lower likelihood of reconstruction when compared with Caucasian patients (OR 0.60 versus 1.00). Patients living in nonmetropolitan regions were also significantly less likely to undergo reconstruction. Receipt of radiation therapy was also negatively correlated with likelihood of reconstruction. In this multicenter, multiyear analysis of factors associated with immediate or early-delayed reconstruction after mastectomy, we demonstrate that younger age, white race, metropolitan locale, and lower stage disease were all independently associated with higher likelihood of reconstruction. This information provides insight into breast reconstruction utilization and will help guide future studies to understand how these factors affect patient and physician decision-making.     

Clinicopathological Characteristics and Survival Analysis of 87 Male Breast Cancer Cases

BACKGROUND: The aim of this study was to investigate the clinicopathologic characteristics, therapy methods, and prognosis of male breast cancer. PATIENTS AND METHODS: We retrospectively analyzed the clinicopathological characteristics, recurrence or metastasis, and survival information of 87 male breast cancer patients. Statistical analysis included the Kaplan-Meier method to analyze survivals, log-rank to compare curves between groups, and Cox regression for multivariate prognostic analysis. A p value of <0.05 was considered statistically significant. RESULTS: 5-year disease free survival (DFS) and 5-year overall survival (OS) were 66.3 and 77.0%, respectively. Monofactorial analysis showed tumor size, stage, lymph node involvement, and adjuvant chemotherapy to be prognostic factors with regard to 5-year DFS and 5-year OS. Multivariate Cox regression analysis showed tumor size, stage, and adjuvant chemotherapy to be independent prognostic factors with regard to 5-year DFS and 5-year OS. CONCLUSION: Male breast cancer has a lower incidence rate and poor prognosis. Invasive ductal carcinoma is the main pathologic type. Operation-based combined therapy is the standard care for these patients. Tumor size, stage, and adjuvant chemotherapy are independent prognostic factors. More emphasis should be placed on early diagnosis and early therapy, and adjuvant chemotherapy may improve survival.     

Importance of race on breast cancer survival

Background: Breast cancer survival has been shown to be significantly less among black women than white women. The reason for this difference in survival is unclear. Methods: Data were obtained retrospectively on 439 women seen between 1985 and 1993 based on a detailed chart audit. The impact of race and several known prognostic factors on overall survival, time to relapse, and survival after relapse were studied. Results: Black women with breast cancer were found to have a greater risk of recurrence, shorter overall survival, and shorter survival after relapse than did white women. Black patients were found to be younger and have higher stage of disease and lower hormone receptor levels than were white patients. After adjustment for menopausal status and disease stage, a significant independent effect of race was observed on overall survival but not risk of recurrence. In multivariate analysis, a significant interaction was observed between race and age in some models. Survival after recurrence of disease was lower among black than white women after adjustment for menopausal status and estrogen receptor level. Conclusion: Black women experience shorter survival times than do white women, including a shorter survival time after disease recurrence. Breast cancer in black women is associated with younger age, higher stage at presentation, and low hormone receptor levels. After adjustment for known prognostic factors, race remains a significant independent predictor of breast cancer survival. Presented at the 32nd Annual Meeting of the American Society of Clinical Oncology, Philadelphia, 1996.     

Predictors of Mastectomy for Women with Breast Cancer in the Greater Western Region of Sydney

This population-based study examined predictors of mastectomy for women with breast cancer in the greater western region of Sydney (GWRS) in New South Wales (NSW), Australia in 1992. Patients with a first diagnosis of breast cancer in 1992, the year prior to population-based mammographic screening in the region, were identified through the NSW state cancer registry. Data on stage, treatment, and demographic and health service characteristics were obtained from hospital records for patients treated within the region. The 282 patients who received surgical treatment for operable disease were considered in this analysis. Logistic regression was used to determine the odds ratio (OR) for mastectomy in relation to predictor variables with adjustment for confounding where appropriate. Age was included in all regressions even though it was not statistically significant. The tumor characteristics that were significant predictors (age adjusted) of mastectomy were stage [I (referent); IIA: OR = 1.5 (ns); IIB / IIIA-B: OR = 6.3, p < 0.05] and tumor size [T0-1 (referent); T2: OR = 1.8, p < 0.05; T3: OR = 12.9, p < 0.05]. There was a significant linear trend (p < 0.05) for lower ORs for mastectomy in women treated by surgeons with a higher breast cancer caseload (adjusted for age and stage). Women from municipalities with high socioeconomic status had lower mastectomy rates than others (OR = 0.5, p < 0.05), adjusted for age, stage, and surgeon activity level. Distance of residence from the main referral hospital and radiotherapy unit did not affect mastectomy rates. This study documents factors, in addition to stage at diagnosis, that play an important part in decisions about surgery for women with operable breast cancer. The experience of the surgeon, measured by the number of breast cancer patients, had an effect, as did the socioeconomic status of the woman. The latter may act through educational characteristics and participation of women in decisions concerning surgery.     

Effects of race and socioeconomic status on survival of 1,332 black, hispanic, and white women with breast cancer

Background: A survival disadvantage for black women with brest cancer, which persists after controlling for stage of the disease, has been reported. This study investigates the effects of race and socioeconomic status (SES) on breast cancer survival after controlling for age, stage, histology, and type of treatment. Methods: Kaplan-Meier and Cox proportional hazards models were used to analyze the interaction between race and SES in predicting survival in a sample of 163 black, 205 Hispanic, and 964 white women with breast cancer treated at M. D. Anderson Cancer Center (1987–1991). Results: The results of univariate and multivariate analyses indicate that race was not a significant predictor of survival after adjusting for SES and other confounding factors such as demographic and disease characteristics. SES remained a significant predictor of survival after all adjustments were made. There was no evidence of differences in type of treatment by race or SES if adjustments were made for stage. Conclusions: These results suggest that institutional factors, such as access to treatment, do not explain survival differences by race or SES. Other factors associated with low SES, such as life-style and behavior, may affect survival.     

Is race a poor prognostic factor in breast cancer?

BACKGROUND: African American breast cancer patients have a higher mortality rate than their Caucasian counterparts. The purpose of this study was to evaluate whether race is a poor prognostic factor in breast cancer survival after multiple other prognostic factors are taken into account. STUDY DESIGN: The tumor registry data from two institutions between the years 1982 and 1995 were combined for the analysis. A total of 1,745 patients, including 1,297 African American and 448 Caucasian women, were available for analysis. Race, age, income, stage, histologic findings, type of operation, and treating institution were evaluated as possible key prognostic variables. RESULTS: In a univariate Cox proportional hazards regression analysis, African American patients with breast cancer were 1.27 times more likely to die than Caucasians when death from disease was measured (p = 0.01, 95% confidence interval 1.03 to 1.47). When all factors were included in a Cox regression analysis, only the stage of disease at diagnosis, age, and whether the patient had a therapeutic surgical treatment were statistically significant. Race, income, hospital, and histologic findings were not significant, although they were significant when used in a univariate analysis. CONCLUSIONS: Poor survival of African American breast cancer patients seems to be related to their advanced stage at presentation and young age. To improve survival in these women, efforts should be concentrated on aggressive screening at a young age to detect the disease at an earlier stage.     

年轻乳腺癌的临床病理特点及预后因素分析：基于SEER数据库的回顾性研究

目的 探讨≤35岁乳腺癌的临床病理特点及预后因素。方法 收集整理美国国立癌症研究所监测、流行病学和结果数据库SEER中2004~2010乳腺癌患者171 799例按照≤35岁或>35岁将患者分成年轻组（4157例）和非年轻组（167 642例）,利用卡法检验分析两组间的临床病理特征差异。采用 Kaplan Meier法计算乳腺癌相关OS和中位生存时间做生存分析,利用Log-Rank检验进行单因素分析,将单因素分析结果中有统计学意义的因素纳入COX比例风险回归模型进行多因素分析,得到影响乳腺癌患者预后的独立危险因素及年轻乳腺患者的预后的独立因素。结果 年轻组相比非年轻组检验中有统计学意义的临床病理因素包括：≤35岁或>35岁、分期、组织学分级、N分期、分子分型、是否购买医疗保险,其中年龄、分期、组织学分级、N分期、分子分型、是否购买医疗保险是影响乳腺癌脑独立影响因素。在KM生存分析当中,Log-Rank检验有统计学意义的因素提示≤35岁乳腺癌患者相比>35岁乳腺癌患者预后更差,在≤35岁乳腺癌患者中,分期、组织学分级、N分期、分子分型、是否购买医疗保险是乳腺癌预后独立影响因素。结论 ≤35岁乳腺癌中,分期更高、组织学分级更高、淋巴结转移个数更多、三阴乳腺癌或HER2阳乳腺癌占比例更多、更多患者没购买医疗保险。≤35岁是影响乳腺癌患者预后的独立危险因素。在≤35岁乳腺癌患者中,分期、组织学分级、N分期、分子分型、是否购买医疗保险是乳腺癌预后独立影响因素。     

Factors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study

BACKGROUND: Advances in surgical techniques and changes in our understanding of the biology of breast cancer have made immediate or early breast reconstruction a viable option for the majority of women with breast cancer. Little is known about national patterns of use of reconstruction. This study was undertaken to determine national patterns of care and factors that influence the use of breast reconstruction. STUDY DESIGN: A large convenience sample reported to the National Cancer Data Base was studied. Patients coded as undergoing mastectomy between 1985 and 1990 (n = 155,463) and between 1994 and 1995 (n = 68,348) were evaluated. The use of reconstruction in the two time periods was compared, and patient and tumor factors influencing the use of the procedure were compared. RESULTS: Between 1985 and 1990, 3.4% of mastectomy patients had early or immediate reconstruction, increasing to 8.3% in 1994-5. Patient age, income, geographic location, type of hospital where treatment occurred, and tumor stage all influenced the use of reconstruction in univariate analysis. In multivariate analysis, patients age 50 or under had a 4.3-fold greater likelihood of having reconstruction than their older counterparts. Patients with ductal carcinoma in situ were twice as likely as those with invasive cancer to have reconstruction. Family income of $40,000 or more (Odds Ratio 2.0), ethnicity other than African-American (Odds Ratio 1.6), surgery in a National Cancer Institute-designated cancer center (Odds Ratio 1.4), and surgery in a geographic region other than the Midwest or South (Odds Ratio 1.3) remained significant predictors of the use of reconstruction in multivariate analysis. CONCLUSIONS: Breast reconstruction is an underused option in breast cancer management. Predictors of the use of reconstruction do not reflect contraindications to the procedure, and indicate the need for both physician and patient education.     

Influence of Race/Ethnicity on Genetic Counseling and Testing for Hereditary Breast and Ovarian Cancer

Abstract:  Risk assessment coupled with genetic counseling and testing for the cancer predisposition genes BRCA1 and BRCA2 ( BRCA1/2 ) has become an integral element of comprehensive patient evaluation and cancer risk management in the United States for individuals meeting high-risk criteria for hereditary breast and ovarian cancer (HBOC). For mutation carriers, several options for risk modification have achieved substantial reductions in future cancer risk. However, several recent studies have shown lower rates of BRCA1/2 counseling and testing among minority populations. Here, we explore the role of race/ethnicity in cancer risk assessment, genetic counseling and genetic testing for HBOC and the BRCA1/2 cancer predisposition genes. Barriers to genetic services related to race/ethnicity and underserved populations, including socioeconomic barriers (e.g., time, access, geographic, language/cultural, awareness, cost) and psychosocial barriers (e.g., medical mistrust, perceived disadvantages to genetic services), as well as additional barriers to care once mutation carriers are identified, will be reviewed.     

Effect of race on long-term survival of breast cancer patients: transinstitutional analysis from an inner city hospital and university medical center

Black women have the highest mortality for breast cancer. Our hypothesis is that racial disparities in breast cancer survival persist after controlling for stage of disease and treatment at both a city hospital as well as at a university hospital. Data from tumor registries of breast cancer patients at a city hospital and a university center were analyzed for overall and disease-specific survival, controlling for stage and treatment. Black patients presented with more advanced stages and had significantly worse survival compared with whites. After controlling for stage of disease and treatment, a difference in survival persisted for stage II patients, with blacks doing worse than whites at both institutions. Although there were socioeconomic differences, race was an independent prognostic factor, with black patients having the worse prognosis. The lower survival of black women with breast cancer is only partially explained by their advanced stage at diagnosis. Black women with potentially curable stage II cancer had a lower survival that is not explained by the variables measured.