Racial variation in breast cancer treatment among Department of Defense beneficiaries

BACKGROUND:

Although the overall age‐adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system.

METHODS:

The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy.

RESULTS:

There was no significant difference in surgery type, particularly when mastectomy was compared with breast‐conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8‐1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9‐1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6‐1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2‐0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3‐0.8).

CONCLUSIONS:

Even within an equal access health care system, stage‐related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within‐stage racial disparities are warranted. Cancer 2012;. © 2011 American Cancer Society.     

Racial Differences in Oral and Pharyngeal Cancer Treatment and Survival in Florida

OBJECTIVE: This study examined racial differences in treatment and survival for blacks and whites in Florida diagnosed with oral or pharyngeal cancer. METHODS: Data for 21,481 malignancies of the oral cavity or pharynx diagnosed from 1988 to 1998 were derived from the Florida Cancer Data System. Type of cancer treatment was compared by race, stratified by anatomic site and summary stage at diagnosis. Kaplan-Meier survival curves were used to compare survival rates and Cox regression models were used to estimate hazard ratios for race. Covariates included age, sex, census tract income, and treatment. RESULTS: Stratifying by tumor site and stage, blacks consistently had poorer survival rates than whites. Across tumor stages, blacks with oral cavity cancer were consistently more likely than whites to have received only radiotherapy and less likely to have received cancer-directed surgery. Trends were similar for pharyngeal cancer, although statistically significant only for regional stages. Across site and stage, blacks consistently had elevated hazard ratios (range: 1.20-1.53) relative to whites. CONCLUSIONS: In Florida, there were racial differences in patient treatment for oral or pharyngeal cancer. Blacks had lower survival rates than whites, but differences in treatment did not entirely account for racial disparities in survival.     

Breast cancer racial disparities: unanswered questions

Breast cancer is the most common noncutaneous cancer diagnosed in women in the United States and is second only to lung cancer as the leading cause of cancer-related mortality. Although mortality rates have been dropping steadily due to a variety of factors including improved treatment modalities and screening, substantial racial differences in outcome between blacks and whites persist. Although differences in health care utilization and access, tumor biology, and cancer management have been elucidated as possible reasons for disparities seen, it is likely that other interactions exist. The purpose of this review is, therefore, to present a comprehensive overview of the literature on racial disparities in breast cancer outcome and highlight potential causative factors that may contribute to disparities seen among blacks and whites with breast cancer. In addition, we make research recommendations by discussing some of the remaining gaps in knowledge that may lead to further understanding of disparities and consequently improved outcomes for all women with breast cancer.     

Breast and prostate cancer survival in Michigan

BACKGROUND:

Racial disparities in survival from breast and prostate cancer are well established; however, the roles of societal/socioeconomic factors and innate/genetic factors in explaining the disparities remain unclear. One approach for evaluating the relative importance of societal and innate factors is to quantify how the magnitude of racial disparities changes according to the geographic scales at which data are aggregated. Disappearance of racial disparities for some levels of aggregation would suggest that modifiable factors not inherent at the individual level are responsible for the disparities.

METHODS:

The Michigan Cancer Surveillance Program compiled a dataset from 1985 to 2002 that included 124,218 breast cancer cases and 120,615 prostate cancer cases with 5‐year survival rates of 78% and 75%, respectively. Absolute and relative differences in survival rates for whites and blacks were quantified across different geographic scales using statistics that adjusted for population size to account for the small numbers problem common with minority populations.

RESULTS:

Whites experienced significantly higher survival rates for prostate and breast cancer compared with blacks throughout much of southern Michigan in analyses conducted using federal House legislative districts; however, in smaller geographic units (state House legislative districts and community‐defined neighborhoods), disparities diminished and virtually disappeared.

CONCLUSIONS:

The current results suggest that modifiable societal factors are responsible for apparent racial disparities in breast and prostate cancer survival observed at larger geographic scales. This research presents a novel strategy for taking advantage of inconsistencies across geographic scales to evaluate the relative importance of innate and societal‐level factors in explaining racial disparities in cancer survival. Cancer 2009. © 2009 American Cancer Society.     

Colorectal cancer incidence in the United States, 1999‐2004

BACKGROUND:

By using recent national cancer surveillance data, the authors investigated colorectal cancer (CRC) incidence by subpopulation to inform the discussion of demographic‐based CRC guidelines.

METHODS:

Data included CRC incidence (1999‐2004) from the combined National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program databases. Incidence rates (age‐specific and age‐adjusted to the 2000 US standard population) were reported among individuals ages 40 to 44 years, 45 to 49 years, 50 to 64 years, and ≥65 years by sex, subsite, disease stage, race, and ethnicity. Rate ratios (RR) and rate differences (RD) were calculated to compare CRC rates in different subpopulations.

RESULTS:

Incidence rates were greater among men compared with women and among blacks compared with whites and other races. Incidence rates among Asians/Pacific Islanders (APIs), American Indians/Alaska Natives (AI/ANs), and Hispanics consistently were lower than among whites and non‐Hispanics. Sex disparities were greatest in the population aged ≥65 years, whereas racial disparities were more pronounced in the population aged <65 years. Although the RD between blacks and whites diminished at older ages, the RD between APIs and whites, between AI/ANs and whites, and between non‐Hispanics and Hispanics increased with increasing age. By subsite, blacks had the highest incidence rates compared with whites and other races in the proximal and distal colon; the reverse was true in the rectum. By stage, whites had higher incidence rates than blacks and other races for localized and regional disease; for distant and unstaged disease, blacks had higher incidence rates than whites.

CONCLUSIONS:

The current findings suggested differences that can be considered in formulating targeted screening and other public health strategies to reduce disparities in CRC incidence in the United States. Cancer 2009. Published 2009 by the American Cancer Society.     

Cancer mortality-to-incidence ratios in Georgia: describing racial cancer disparities and potential geographic determinants

BACKGROUND:

The objective of this study was to evaluate racial cancer disparities in Georgia by calculating and comparing mortality‐to‐incidence ratios (MIRs) by health district and in relation to geographic factors.

METHODS:

Data sources included cancer incidence (Georgia Comprehensive Cancer Registry), cancer mortality (Georgia Vital Records), and health factor (County Health Rankings) data. Age‐adjusted incidence and mortality rates were calculated by cancer site (all sites combined, lung, colorectal, prostate, breast, oral, and cervical) for 2003‐2007. MIRs and 95% confidence intervals were calculated overall and by district for each cancer site, race, and sex. MIRs were mapped by district and compared with geographic health factors.

RESULTS:

In total, 186,419 incident cases and 71,533 deaths were identified. Blacks had higher MIRs than whites for every cancer site evaluated, and especially large differentials were observed for prostate, cervical, and oral cancer in men. Large geographic disparities were detected, with larger MIRs, chiefly among blacks, in Georgia compared with national data. The highest MIRs were detected in west and east central Georgia, and the lowest MIRs were detected in and around Atlanta. Districts with better health behavior, clinical care, and social/economic factors had lower MIRs, especially among whites.

CONCLUSIONS:

More fatal cancers, particularly prostate, cervical, and oral cancer in men were detected among blacks, especially in central Georgia, where health behavior and social/economic factors were worse. MIRs are an efficient indicator of survival and provide insight into racial cancer disparities. Additional examination of geographic determinants of cancer fatality in Georgia as indicated by MIRs is warranted. Cancer 2012. © 2012 American Cancer Society     

Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries

BACKGROUND:

Tumor stage at diagnosis often varies by racial/ethnic group, possibly because of inequitable health care access. Within the Department of Defense (DoD) Military Health System, beneficiaries have equal health care access. The objective of this study was to determine whether tumor stage differed between whites and blacks with breast, cervical, colorectal, and prostate cancers, which have effective screening regimens, based on data from the DoD Automated Cancer Tumor Registry from 1990 to 2003.

METHODS:

Distributions of tumor stage (localized vs nonlocalized) between whites and blacks in the military were compared stratified by sex, active duty status, and age at diagnosis. Logistic regression was used to further adjust for age, marital status, year of diagnosis, geographic region, military service branch, and tumor grade. Distributions of tumor stage were then compared between the military and general populations.

RESULTS:

Racial differences in the distribution of stage were significant only among nonactive duty beneficiaries. After adjusting for covariates, earlier stages of breast cancer after age 49 years and prostate cancer after age 64 years were significantly more common among white than black nonactive duty beneficiaries (P < .05), although the absolute difference was minimal for prostate cancer. Racial differences in stage for cervical and colorectal cancers were not significant after adjustment. Compared with the general population, racial differences in the military were similar or were slightly attenuated.

CONCLUSIONS:

Racial disparities in stage at diagnosis were apparent in the DoD equal‐access health care system among older nonactive duty beneficiaries. Socioeconomic status, supplemental insurance, cultural beliefs, and biologic factors may be related to these results. Cancer 2012;. © 2011 American Cancer Society.     

A black‐white comparison of the quality of stage‐specific colon cancer treatment

BACKGROUND:

Several studies have attributed racial disparities in cancer incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institute of Medicine report found that blacks received lower quality care than whites after controlling for health insurance, income, and disease severity.

METHODS:

To examine the effects of race on colorectal cancer outcomes within a single setting, the authors performed a retrospective cohort study that analyzed the cancer registry, billing, and medical records of 365 university hospital patients (175 blacks and 190 whites) diagnosed with stage II‐IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage‐specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, sex, age, and marital status.

RESULTS:

Blacks and whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although few patients (5.8%) were uninsured, they were more likely to present at advanced stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients (p = .002).

CONCLUSIONS:

In a population without racial differences in socioeconomic status or insurance coverage, patients receive the same quality of care, regardless of racial distinction, and have similar health outcomes. Age, diagnostic stage, and health insurance coverage remained independently associated with mortality. Future studies of disparities in colon cancer treatment should examine sociocultural barriers to accessing appropriate care in various healthcare settings. Cancer 2010. © 2009 American Cancer Society.     

Treatment plans for black and white women with stage II node-positive breast cancer. The National Cancer Institute Black/White Cancer Survival Study experience.

BACKGROUND. The National Cancer Institute Black/White Cancer Survival Study began patient accrual in 1985 and was designed to investigate factors that might contribute to the observed racial differences in survival for cancer of the breast, uterine corpus, colon, and bladder. METHODS. To determine whether there were racial differences in treatment in a clinically homogeneous set of patients, 305 (25%) of the 1222 women in this study with Stage II node-positive (N+) breast cancer were evaluated. RESULTS. Patient characteristics for blacks and whites were similar for age, metropolitan area of residence, tumor size, extent of nodal involvement, and steroid receptors. Differences in histologic findings, tumor grade, and nuclear atypia were observed. Blacks had a higher frequency of comorbid conditions, especially hypertension (P < 0.00001). Fewer blacks underwent breast-conserving surgery (P = 0.004). In a multivariate analysis, race was no longer a significant factor in the selection of primary treatment, but education and metropolitan area of residence remained significant. Blacks and whites received similar postoperative systemic therapy, with combination chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and tamoxifen, the most common cytotoxic and endocrine therapies used. CONCLUSIONS. The National Cancer Institute consensus statement concerning adjuvant therapy for breast cancer was published in the middle of the 2-year period that study cases were accrued, and treatment plans in this study generally agreed with consensus guidelines. Should survival differences in black and white patients with Stage II N+ disease in this study be found, they are unlikely to be attributable to differences in initial or postoperative treatment.     

Racial disparities in the use of radiotherapy after breast‐conserving surgery: A national Medicare study

BACKGROUND:

In prior studies, the use of standard breast cancer treatments has varied by race, but previous analyses were not nationally representative. Therefore, in a comprehensive, national cohort of Medicare patients, racial disparities in the use of radiotherapy (RT) after breast‐conserving surgery (BCS) for invasive breast cancer were quantified.

METHODS:

A national Medicare database was used to identify all beneficiaries (age >65 years) treated with BCS for incident invasive breast cancer in 2003. Claims codes identified RT use, and Medicare demographic data indicated race. Logistic regression modeled RT use in white, black, and other‐race patients, adjusted for demographic, clinical, and socioeconomic covariates.

RESULTS:

Of 34,080 women, 91% were white, 6% were black, and 3% were another race. The mean age of the patients was 76 ± 7 years. Approximately 74% of whites, 65% of blacks, and 66% of other‐race patients received RT (P < .001). After covariate adjustment, whites were found to be significantly more likely to receive RT than blacks (odds ratio, 1.48; 95% confidence interval, 1.34‐1.63 [P < .001]). Disparities between white and black patients varied by geographic region, with blacks in areas of the northeastern and southern United States demonstrating the lowest rates of RT use (57% in these regions). In patients age <70 years, racial disparities persisted. Specifically, 83% of whites, 73% of blacks, and 78% of other races in this younger group received RT (P < .001).

CONCLUSIONS:

In this comprehensive national sample of older breast cancer patients, substantial racial disparities were identified in RT use after BCS across much of the United States. Efforts to improve breast cancer care require overcoming these disparities, which exist on a national scale. Cancer 2010. © 2009 American Cancer Society.     

Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival: findings from the National Longitudinal Mortality Study, 1979-2003

BACKGROUND:

This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual‐level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival.

METHODS:

This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥25 years, identified from the National Longitudinal Mortality Study‐SEER data during 1973 to 2003. Kaplan‐Meier methods and Cox regression models were used for survival analysis.

RESULTS:

Three‐year all‐cause observed survival for cases diagnosed with local‐stage cancers of the 8 leading tumors combined was ≥82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first‐course cancer‐directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer‐specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1‐1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9‐1.1). HRs for all‐cause mortality among patients with breast cancer and for cancer‐specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics.

CONCLUSIONS:

Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual‐level socioeconomic factors and treatment for patients with breast and prostate cancer. Cancer 2011. © 2011 American Cancer Society.     

Racial patterns of childhood brain cancer by histologic type

Racial patterns of childhood brain cancer by histologic type were studied using data from the Third National Cancer Survey and the Surveillance, Epidemiology, and End Results Program. Incidence rates for whites of all types combined and of astrocytic glioma and medulloblastoma were slightly higher than those for blacks. Proportionately more black than white cases of astrocytic glioma were diagnosed between the ages of 5-9 years; this difference corresponded to twofold-higher rates at ages of 0-4 and 10-14 years and similar rates at ages of 5-9 years among whites compared to rates among nonwhites. A real difference in age-incidence curves rather than diagnostic delay among blacks appeared to explain the differences. For medulloblastoma, the male-female rate ratio differed between whites (1.7) and blacks (1.0). Time trend analyses revealed statistically significant increases in medulloblastoma and glioma not otherwise specified (NOS) for incidences among blacks. The rate of microscopic confirmation was significantly higher among whites than among blacks, a difference apparently not explained by differences in the accessibility of tumors for biopsy. For avoidance of biased comparisons, differences in rates of microscopic confirmation and time trends for glioma NOS should be considered in studies of racial patterns of childhood brain cancer incidence by histologic type.     

Within-stage racial differences in tumor size and number of positive lymph nodes in women with breast cancer

BACKGROUND: Black women have higher breast cancer mortality rates, are more likely to be diagnosed at an advanced stage of disease, and have worse stage-for-stage survival than white women. It was hypothesized that differences in the tumor size and number of positive lymph nodes within each disease stage contribute to the survival disparity. METHODS: In the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, black and white women diagnosed with a first primary tumor (TNM stage I-IIIA breast cancer) between 1988 and 2003 were identified. The demographic and clinical characteristics were compared by race. Logistic regression models of the association between race and tumor size and lymph node status were developed. Cox proportional hazards models of the association between mortality and race, tumor size, lymph node status, and other covariates were also examined. RESULTS: Among 256,174 SEER cases (21,861 black and 234,313 white women), more black than white women with lymph node-negative breast cancer had tumors measuring >or=2.0 cm. Adjusted for tumor size, more black than white women had >or=1 positive lymph nodes (odds ratio [OR], 1.24; 95% confidence interval [95% CI], 1.20-1.28). The age-adjusted and TNM stage-adjusted mortality rate ratio for blacks versus whites was 1.56 (95% CI, 1.51-1.61). Adjustment for within-stage differences in tumor size and lymph node involvement were found to have a negligible effect. With adjustment for additional covariates, the rate ratio was 1.39 (95% CI, 1.35-1.44). In addition, the rate ratio reflecting racial disparity increased as the stage of disease increased. CONCLUSIONS.: Adjusting for within-stage differences in tumor size and lymph node status did not appear to reduce the racial disparity. The finding that disparities increased with higher stage of disease suggests that interventions aimed at reducing these differences should target women with more advanced disease.     

Racial differences in breast cancer patients

One thousand seventy-eight patients diagnosed with primary breast cancer were examined for racial differences in histopathologic and clinical parameters. There were no observed differences in tumor histopathologic type or tumor endocrine status between races. There were no differences with respect to time to breast tumor recurrence observed between black and white patients. However, differences were observed in factors that contributed to tumor stage at diagnosis and to tumor grade. Survival differences observed in univariant analysis of blacks vs. whites were explainable by the presence of more severe skin involvement, tumor grade, and tumor size at diagnosis in the black patients.     

Racial disparities in breast carcinoma survival rates: seperating factors that affect diagnosis from factors that affect treatment

BACKGROUND: Black females have lower breast carcinoma survival rates compared with white females. One possible reason is that black females have more advanced-stage breast disease. Another factor may be racial differences in the utilization of cancer treatments. METHODS: The authors determined racial differences in 6-year stage specific survival rates, adjusting for age and treatments (using estrogen receptor [ER] status), to determine whether there were racial differences in treatment. Racial differences in the stage distributions of breast disease were used to examine the impact of racial factors on breast carcinoma diagnosis. RESULTS: For all breast carcinoma cases, the stage specific 6-year survival rates, in general, were significantly lower for black females for all stages combined and for Stages I-III in every age group. However, examination by different treatments, as measured by ER status, revealed some different results. Only black women younger than age 50 years with ER-positive tumors and women younger than age 65 years with ER-negative tumors had significantly lower stage-specific survival rates. In addition, the stage distribution analyses showed that black females of every age group had less Stage I breast disease. CONCLUSIONS: For younger black women (younger than age 50 years), there was evidence of racial differences in treatment for both women with ER-positive tumors and women with ER-negative tumors, as indicated by their lower stage-specific survival rates. In contrast, for black females age 65 years or older with ER-positive or ER-negative tumors, the lack of a significant difference in the stage-specific survival rate suggests that Medicare may help to alleviate racial disparities in cancer treatment. Furthermore, racial differences in the stage distributions indicated the need for earlier diagnosis for black females of every age.     

Racial disparities in colorectal cancer survival

BACKGROUND:

Racial/ethnic differences in colorectal cancer (CRC) survival have been documented throughout the literature. However, the reasons for these disparities are difficult to decipher. The objective of this analysis was to determine the extent to which racial/ethnic disparities in survival are explained by differences in sociodemographics, tumor characteristics, diagnosis, treatment, and hospital characteristics.

METHODS:

A cohort of 37,769 Medicare beneficiaries who were diagnosed with American Joint Committee on Cancer stages I, II, and III CRC from 1992 to 2002 and resided in 16 Surveillance, Epidemiology, and End Results (SEER) regions of the United States was identified in the SEER‐Medicare linked database. Survival was estimated using the Kaplan‐Meier method. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) of mortality and 95% confidence intervals (CIs).

RESULTS:

Black patients had worse CRC‐specific survival than white patients, but the difference was reduced after adjustment (adjusted HR [aHR], 1.24; 95% CI, 1.14‐1.35). Asian patients had better survival than white patients after adjusting for covariates (aHR, 0.80; 95% CI, 0.70‐0.92) for stages I, II, and III CRC. Relative to Asians, blacks and whites had worse survival after adjustment (blacks: aHR, 1.56; 95% CI, 1.33‐1.82; whites: aHR, 1.26; 95% CI, 1.10‐1.44). Comorbidities and socioeconomic Status were associated with a reduction in the mortality difference between blacks and whites and blacks and Asians.

CONCLUSIONS:

Comorbidities and SES appeared to be more important factors contributing to poorer survival among black patients relative to white and Asian patients. However, racial/ethnic differences in CRC survival were not fully explained by differences in several factors. Future research should further examine the role of quality of care and the benefits of treatment and post‐treatment surveillance in survival disparities. Cancer 2010. © 2010 American Cancer Society.     

Incidence of Male Breast Cancer in California, 1988–2000: Racial/Ethnic Variation in 1759 Men

Breast cancer among males is rare, accounting for less than 1% of all breast cancers in the United States. Although it is rare, it can cause significant morbidity and mortality. We analyzed data from 1759 California males whose diagnosis of breast cancer was made between 1988 and 2000 and reported to the population-based California Cancer Registry. Cases were primary, microscopically confirmed in situ and invasive breast cancer. Age-adjusted incidence rates per 100,000 men were highest in Blacks (1.65), intermediate in whites (1.31) and lowest in Hispanics and Asian/Pacific Islanders (0.68, 0.66, respectively). Age at diagnosis differed by race (p = 0.001) with blacks diagnosed at an earlier age than whites or Asians/Pacific Islanders. Stage at diagnosis also differed by race (p = 0.001) with blacks more likely to be diagnosed at distant stage. Further investigation showed that blacks and Hispanics were more likely to be diagnosed with tumors 5 cm in diameter or greater. The proportion of men having surgery following a diagnosis of breast cancer also varied by race/ethnicity (p = 0.001) with blacks least likely to have surgery following diagnosis. Understanding racial/ethnic variation in male breast cancer may provide clinical and etiologic implications for breast cancer in different populations.     

Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities

In this article, the American Cancer Society provides the estimated number of new cancer cases and deaths for blacks in the United States and the most recent data on cancer incidence, mortality, survival, screening, and risk factors for cancer. Incidence data are from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries, and mortality data are from the National Center for Health Statistics. Approximately 189,910 new cases of cancer and 69,410 cancer deaths will occur among blacks in 2016. Although blacks continue to have higher cancer death rates than whites, the disparity has narrowed for all cancers combined in men and women and for lung and prostate cancers in men. In contrast, the racial gap in death rates has widened for breast cancer in women and remained level for colorectal cancer in men. The reduction in overall cancer death rates since the early 1990s translates to the avoidance of more than 300,000 deaths among blacks. In men, incidence rates from 2003 to 2012 decreased for all cancers combined (by 2.0% per year) as well as for the top 3 cancer sites (prostate, lung, and colorectal). In women, overall rates during the corresponding time period remained unchanged, reflecting increasing trends in breast cancer combined with decreasing trends in lung and colorectal cancer rates. Five‐year relative survival is lower for blacks than whites for most cancers at each stage of diagnosis. The extent to which these disparities reflect unequal access to health care versus other factors remains an active area of research. Progress in reducing cancer death rates could be accelerated by ensuring equitable access to prevention, early detection, and high‐quality treatment. CA Cancer J Clin 2016;66:290‐308. © 2016 American Cancer Society     

Racial disparities in cancer therapy

BACKGROUND: The purpose of this study was to determine whether racial disparities in cancer therapy had diminished since the time they were initially documented in the early 1990s. METHODS: The authors identified a cohort of patients in the SEER-Medicare linked database who were ages 66 to 85 years and who had a primary diagnosis of colorectal, breast, lung, or prostate cancer during 1992 through 2002. The authors identified 7 stage-specific processes of cancer therapy by using Medicare claims. Candidate covariates in multivariate logistic regression included year, clinical, and sociodemographic characteristics, and physician access before cancer diagnosis. RESULTS: During the full study period, black patients were significantly less likely than white patients to receive therapy for cancers of the lung (surgical resection of early stage, 64.0% vs 78.5% for blacks and whites, respectively), breast (radiation after lumpectomy, 77.8% vs 85.8%), colon (adjuvant therapy for stage III, 52.1% vs 64.1%), and prostate (definitive therapy for early stage, 72.4% vs 77.2%, respectively). For both black and white patients, there was little or no improvement in the proportion of patients receiving therapy for most cancer therapies studied, and there was no decrease in the magnitude of any of these racial disparities between 1992 and 2002. Racial disparities persisted even after restricting the analysis to patients who had physician access before their diagnosis. CONCLUSIONS: There has been little improvement in either the overall proportion of Medicare beneficiaries receiving cancer therapies or the magnitude of racial disparity. Efforts in the last decade to mitigate cancer therapy disparities appear to have been unsuccessful.     

Social and biological factors in relation to survival among black vs. white women with breast cancer

Summary Longer survival for white women than black women with breast cancer has been observed even when relative survival rates are used and stage at diagnosis is controlled. This study compared prognostic factors in relation to survival for 144 white women and 67 black women with breast cancer diagnosed 1969 to 1979 and identified through the tumor registry. Data were obtained from medical records, the registry, death certificates, and pathology files. Median survival was 7.5 years for whites, vs. 5.6 years for blacks. Significant differences between races were also observed for histological type and grade of tumor, presenting symptoms, and health status at diagnosis. Although Cox multiple regression analyses showed pathological stage at diagnosis and number of positive nodes to be the best predictors of survival in both whites and blacks, the differences in histological type observed in this sample merits further research; blacks have fewer well-differentiated tumors, the type associated with positive estrogen receptors and with better survival.