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The Influence of Black Race on Treatment and Mortality for Early-Stage Breast Cancer

Berz, Jonathan P. B. MD*; Johnston, Katherine MD, MA, MSc; Backus, Bertina MPH; Doros, Gheorghe PhD§; Rose, Adam J. MD, MSc; Pierre, Snaltze MPH; Battaglia, Tracy A. MD, MPH*∥

doi: 10.1097/MLR.0b013e31819e1f2b
Original Article

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.

From the *Section of General Internal Medicine, Boston University Medical Center, Boston, Massachusetts; †Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ‡Massachusetts Department of Public Health, Boston, Massachusetts; §Boston University School of Public Health, Boston, Massachusetts; ¶Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, Massachusetts; and ∥Women’s Health Unit, Section of General Internal Medicine, Boston University Medical Center, Boston, Massachusetts.

Supported by the Physician Training Award in Preventive Medicine American Cancer Society (PTAPM-97-185-04), and also supported by Career Development Award from the Veterans Affairs Health Services Research and Development Service (to A.J.R.).

The opinions expressed in this article are those of the authors and do not necessarily represent the official views of the Department of Veterans Affairs.

Reprints: Jonathan PB Berz, MD, Section of General Internal Medicine, Boston University Medical Center, Crosstown Building, 2nd Floor, 801 Massachusetts Ave., Boston, MA 02118. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.