Breast Cancer Survival among Economically Disadvantaged Women: The Influences of Delayed Diagnosis and Treatment on Mortality

^{1 1}Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina; ²South Carolina Statewide Cancer Prevention and Control Program; and ³Palmetto Baptist Breast Health Center, Columbia, South Carolina; and ⁴Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland

^* To whom correspondence should be addressed. E-mail: esmith{at}swmail.sw.org.

	Abstract

Breast cancer affects thousands each year in the United States, and disproportionately affects certain subgroups. For example, the incidence of breast cancer in South Carolina is lower in African American compared with European American women by 12% to 15%, but their mortality rate is twice as high as in European American women. The purpose of the study was to assess factors associated with breast cancer mortality between African American and European American women. Participants (n = 314) in South Carolina's Breast and Cervical Cancer Early Detection Program (SCBCCEDP), which provides breast cancer screening and treatment services, during the years 1996-2004 were included in the study. Data, including tumor characteristics, delay intervals, and race, were examined using the ² test and the Wilcoxon rank-sum test. Cox regression modeling was used to assess the relationship between delay intervals and other factors. No racial differences were found in age at diagnosis, tumor characteristics, or delay intervals. Time delay intervals did not explain differences and mortality rates by race. Survival, however, was affected by prognostic factors as well as by a significant interaction between hormone-receptor status and race. Despite the excellent record of the SCBCCEDP in screening and diagnostic or treatment referrals, the racial disparities in breast cancer mortality continue to exist in South Carolina. These findings highlight the need for future research into the etiology of racial differences, and their impact on breast cancer survival. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2882–90)

Key Words: breast cancer, racial disparities, diagnosis intervals, National Breast and Cervical Cancer Early Detection Program