The influence of black race on treatment and mortality for early-stage breast cancer.

BACKGROUND: Black Americans have higher mortality from breast cancer than white Americans. This study explores the influence of socioeconomic factors and black race on treatment and mortality for early-stage breast cancer. METHODS: A cohort of 21,848 female black and white, non-Hispanic subjects from the Massachusetts Cancer Registry diagnosed with stage I or II breast cancer between 1999-2004 was studied. Subjects with tumors larger than 5 cm were excluded. We used mixed modeling methods to assess the impact of race on guideline concordant care (GCC), defined as receipt of mastectomy or breast conserving surgery plus radiation. Cox proportional hazard regression was used to assess disease-specific mortality. RESULTS: Blacks were less likely to receive GCC after adjusting for age and clinical variables (OR: 0.75; 95% CI: 0.61, 0.92). Marital status and insurance were predictors of receipt of GCC. After adjustment for all covariates, there were no longer significant differences between black and white women regarding the receipt of GCC. Nevertheless, black women were more likely to die of early-stage breast cancer than white women after adjusting for clinical, treatment, socioeconomic variables, and reporting hospital (HR: 1.6; 95% CI: 1.1-2.1). CONCLUSIONS: Socioeconomic factors are mediators of racial differences in treatment outcomes. Significant racial differences exist in disease-specific mortality for women with early-stage breast cancer. Attention to reducing socioeconomic barriers to care may influence racial differences in breast cancer treatment and mortality.

Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002.

BACKGROUND: Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE: We sought to compare the proportions of black and white men receiving aggressive therapy for newly diagnosed nonmetastatic prostate cancer between 1998 and 2002, accounting for the clustering of outcomes by facility. METHODS: We used the Massachusetts Cancer Registry of all cancer diagnosed in residents of Massachusetts. We used logistic regression, clustering by the facility where the tumor was diagnosed, to predict the probability that a patient would receive any aggressive therapy, and the specific therapeutic choices of radical prostatectomy, external-beam radiation therapy, and brachytherapy. Predictors included race, age, poverty, insurance status, marital status, year of diagnosis, and tumor grade. RESULTS: Black men were similarly likely to receive aggressive therapy compared with white men (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.62-1.01). However, there was a racial difference in the receipt of particular types of therapy: black men were significantly more likely to receive radiation therapy (OR 1.39, 95% CI 1.16-1.68) and less likely to receive radical prostatectomy (OR 0.53, 95% CI 0.38-0.74). CONCLUSIONS: Among men diagnosed with nonmetastatic prostate cancer in Massachusetts from 1998 to 2002, black men received aggressive therapy at rates approaching those of whites. However, they were more likely to receive radiation therapy and less likely to receive radical prostatectomy.