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4 September 2008
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Ethnicity gap for advanced breast cancer mortality worsening
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MedWire News: Black patients with advanced-stage breast cancer are missing out on the gains in survival rates made in the last 20 years, study results suggest.
Between 1988 and 2003 survival rates among White patients with advanced disease increased several points, but have, at best, remained static among their Black counterparts, report Sharon Giordano (The University of Texas MD Anderson Cancer Center, Houston, USA) and colleagues.
Clearly, potential disparities in treatment have to be considered, say the researchers, however, another explanation could lie in the fact that most of the net survival gains made were among estrogen-receptor positive cancers, which are inherently less frequent in Black women.
Overall, survival appears to be improving for patients with breast cancer of any stage, with mortality rates decreasing by approximately 2.3% annually.
In part, this decline in mortality can be attributed to more widespread participation in screening programs, with a greater proportion of patients being diagnosed with in situ and early-stage breast cancer.
Furthermore, the decline in mortality rates is also a result of the increasing use of adjuvant anthracyline-based polychemotherapy regimens and the monoclonal antibody trastuzumab, both of which have been associated with improved survival in clinical trials.
However, it is not known whether these gains in survival have been felt among patients who present with metstatic disease at diagnosis - a group which makes up around 10% of all diagnosed cases.
The researchers investigated data on 15,438 women with stage IV breast cancer who were followed up for 16 months, 18 months, and 11 months in the time periods between 1988 and 1993, 1994 and 1998, and 1999 and 2003, respectively.
Overall, 1-year survival rates in these respective time points for women of all ethnicities was 57.4%, 59.1%, and 61.3% - a statistically significant improvement.
By contrast, stratifying the patients by ethnicity revealed that Black women had respective survival rates of 55.1%, 52.0%, and 54.8% - a non-significant trend for worsening survival.
Giordano and colleagues comment in the Journal of Clinical Oncology: "Health policymakers need to be aware of this increasing gap in survival and study the possible causes of such evolving discrepancies and implement appropriate steps to halt and reverse this phenomenon."
J Clin Oncol 2008; Advance online publication
http://jco.ascopubs.org/
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