The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality

Richard Sposto, Theresa H Keegan, Cheryl Vigen, Marilyn L. Kwan, Leslie Bernstein, Esther M. John, Iona Cheng, Juan Yang, Jocelyn Koo, Allison W. Kurian, Bette J. Caan, Yani Lu, Kristine R. Monroe, Salma Shariff-Marco, Scarlett Lin Gomez, Anna H. Wu

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: Racial/ethnic disparity in breast cancer-specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer-specific mortality can explain this disparity. Methods: The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ ethnic disparity in breast cancer-specific mortality. Results: The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer-specific HRs relative to Whites were 1.69 (95% CI, 1.46-1.96), 1.00 (0.84-1.19), and 0.52 (0.33-0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96-1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity. Conclusions: Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer-specific mortality, they do not explain racial/ethnic mortality disparity. Impact: Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality.

Original languageEnglish (US)
Pages (from-to)1064-1072
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Volume25
Issue number7
DOIs
StatePublished - Jul 1 2016

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

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    Sposto, R., Keegan, T. H., Vigen, C., Kwan, M. L., Bernstein, L., John, E. M., Cheng, I., Yang, J., Koo, J., Kurian, A. W., Caan, B. J., Lu, Y., Monroe, K. R., Shariff-Marco, S., Gomez, S. L., & Wu, A. H. (2016). The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality. Cancer Epidemiology Biomarkers and Prevention, 25(7), 1064-1072. https://doi.org/10.1158/1055-9965.EPI-15-1326