Survival disparities persist for Black women with breast cancer

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Disclosures:
University of Central Florida College of Medicine supported the study. Hines reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.


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Black women with invasive breast cancer continued to experience significant disparities in survival compared with their white counterparts, according to an analysis of Florida data published in Cancer Epidemiology, Biomarkers & Prevention.

The rate of breast cancer-associated mortality was twofold higher among Black women compared with white women from 2010 to 2015, the most recent period for which data exist, researchers noted.


Robert Brooks Hines, PhD, MPH, associate professor in the department of population health sciences at University of Central Florida College of Medicine



“We wanted to get a sense of where we have been and where we are, as a state, in eliminating disparities in breast cancer survival according to race/ethnicity. We also wanted to evaluate the degree to which efforts to improve breast cancer outcomes for minority women in Florida have been successful,” Robert Brooks Hines, PhD, MPH, associate professor in the department of population health sciences at University of Central Florida College of Medicine, told Healio. “On a national level, disparities in cancer survival have proven stubbornly persistent. If we found the same thing in our study, it would indicate that additional efforts are needed to ensure equitable breast cancer outcomes for all women in Florida.”

Although progress has been made toward improving racial/ethnic disparities in breast cancer outcomes, additional targeted efforts are needed to eliminate the gaps in survival for Black women, Hines added.

“This will require identifying underlying factors that drive the survival disparity and developing approaches to mitigate the detrimental impact of these factors on the survival of Black women with breast cancer,” he said.

Hines and colleagues of the retrospective cohort study used data from the Florida Cancer Data System to evaluate survival trends among 257,171 women (79.5% white; 10.5% Black; 10% Hispanic) diagnosed with invasive breast cancer between 1990 and 2015. Researchers grouped women according to year of diagnosis: 1990 to 1994, 1995 to 2004 and 2005 to 2015.

Results showed an improvement in mortality rates for all racial/ethnic groups, with Black and Hispanic women showing greater absolute and relative improvements in almost all metrics compared with white women, according to the researchers.

Specifically, 10-year mortality decreased from 36% in 1990 to 1994 to 25.9% in 2010 to 2015 for Black women, representing a 28.06% difference; from 24.5% to 15.8% among Hispanic women, representing a 35.51% difference; and from 20.6% to 14% for white women, representing a 32.04% difference.

Still, researchers observed a twofold increase in 5-year (subdistribution HR [sHR] = 2.04; 95% CI, 1.91-2.19) and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-associated mortality among Black women compared with white women between 2010 and 2015.

In an analysis restricted to women diagnosed in the most recent period adjusted for age, insurance status, census-tract poverty level, tumor stage and grade at diagnosis, and treatment received, researchers found that the 10-year relative rate for breast cancer-associated mortality decreased from 102% higher to 20% higher (sHR = 1.2; 95% CI, 1.14-1.27) among Black women vs. white women. The risk reversed for Hispanic women in the adjust analysis, with a 17% reduction in risk (sHR = 0.83; 95% CI, 0.78-0.88).

“We were encouraged that gains in breast cancer survival occurred for all women and that greater gains were seen among minority women,” Hines said. “A positive finding that was somewhat surprising was that there is no longer any detrimental effect associated with Hispanic ethnicity for white women. However, the considerably poorer survival for Black women, regardless of Hispanic ethnicity, is troubling, although not necessarily surprising, when looking at other studies in the United States.”

Hines and colleagues are now conducting a study to identify the key factors driving the survival disparity among Black women in Florida.

“Once we know what these factors are, this information can then be used to inform policies, programs and interventions that will have the greatest potential to impact the prognosis for these women. The goal is to eliminate race as a prognostic factor for women diagnosed with breast cancer,” Hines said. “The barriers to receiving high-quality cancer care are greater for underserved populations. Clinic or health system-based efforts to remove these barriers will increase the likelihood that these women receive the highest-quality treatment for their cancer. Ensuring that all women diagnosed with breast cancer get the best treatment for their disease would be a major step in the right direction to address survival disparities.”

For more information:

Robert Brooks Hines, PhD, MPH, can be reached at University of Central Florida College of Medicine, 6900 Lake Nona Blvd., Orlando, FL 32827; email: robert.hines@ucsf.edu.



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