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Article first published online: 20 JUN 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 1, pages 196–204, 1 January 2012
How to Cite
Martinez, S. R., Tseng, W. H., Canter, R. J., Chen, A. M., Chen, S. L. and Bold, R. J. (2012), Do radiation use disparities influence survival in patients with advanced breast cancer?. Cancer, 118: 196–204. doi: 10.1002/cncr.26231
Presented in part at the Clinical and Translational Research and Education Meeting, sponsored by the Association for Clinical Research Training and the Society for Clinical and Translational Science, Washington, D.C., April 5-7, 2010.
Information on the National Center for Research Resources is available at http://www.ncrr.nih.gov/ Information on Reengineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp
No patient photos were used in this report; this research was exempt from University of California Davis Institutional Review Board review. No copyrighted material has been used.
- Issue published online: 16 DEC 2011
- Article first published online: 20 JUN 2011
- Manuscript Accepted: 12 APR 2011
- Manuscript Revised: 8 MAR 2011
- Manuscript Received: 25 JAN 2011
- advanced breast cancer;
The authors previously identified racial/ethnic disparities in the use of radiation therapy (RT) in patients with advanced breast cancer (BC). They hypothesized that disparities in the use of RT were associated with survival differences favoring white patients.
The authors used the Surveillance, Epidemiology, and End Results database to identify white, black, Hispanic, and Asian patients with BC associated with ≥10 metastatic lymph nodes diagnosed between 1988 and 2005. Multivariate analyses of overall survival (OS) and disease-specific survival (DSS) assessed age, sex, race, tumor size, histology, estrogen receptor status, progesterone receptor status, RT, and type of surgery. The authors further stratified for use of RT and type of surgery. Risk of mortality was reported as hazard ratios (HRs) with 95% confidence intervals (CIs).
Of 15,895 patients with advanced BC, 12,653 met entry criteria. On multivariate analysis, RT was associated with a decreased risk of all-cause (HR, 0.78; 95% CI 0.74-0.83; P < .001) and disease-specific (HR, 0.81; 95% CI, 0.76-0.86; P < .001) mortality; black race was associated with an increased risk of all-cause (HR, 1.54; 95% CI, 1.42-1.68; P < .001) and disease-specific (HR, 1.53; 95% CI, 1.39-1.68; P < .001) mortality. After stratifying by type of surgery and use of RT, blacks demonstrated poorer survival than their white counterparts, regardless of surgery type or receipt of RT.
Only black patients had poorer OS and DSS relative to whites. When stratified by type of surgery and use of RT, blacks continued to demonstrate poorer survival. This survival disparity is unlikely to be because of lack of RT. Cancer 2012;. © 2011 American Cancer Society.