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Racial disparities in treatment and survival of male breast cancer.

AbstractPURPOSE: Black women with breast cancer have poorer survival than do white women, but little is known about racial disparities in male breast cancer. We analyzed race and other predictors of treatment and survival among men with stage I-III breast cancer. PATIENTS AND METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) Medicare database to identify men 65 years of age or older diagnosed with stage I-III breast cancer from 1991 to 2002. Multivariate regression was used to compare those treated with those not treated with either chemotherapy or radiation therapy, adjusting for known clinical and demographic factors. Cox proportional hazards regression models were used to analyze survival. RESULTS: Of 510 male breast cancer cases (456 white, 34 black), 94% underwent mastectomy, 28% received adjuvant chemotherapy, and 29% received radiation therapy. Among those with known hormone receptors, 95% had hormone-sensitive tumors. In a multivariate analysis, chemotherapy was associated with younger age, advanced stage, and hormone receptor-negative tumors. Radiation therapy was associated with younger age and advanced stage. Black men were approximately 50% less likely to undergo consultation with an oncologist and subsequently receive chemotherapy; however, the results did not reach statistical significance. The breast cancer-specific mortality hazard ratio was more than tripled for black versus white men (hazard ratio = 3.29; 95% CI, 1.10 to 9.86). CONCLUSION: After adjustment for known clinical, demographic, and treatment factors, there was an association of black race with increased male breast cancer-specific mortality. Although male breast cancer is rare, the reasons for these disparities need to be better understood.
AuthorsKatherine D Crew, Alfred I Neugut, Xiaoyan Wang, Judith S Jacobson, Victor R Grann, George Raptis, Dawn L Hershman (Affiliation: Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. dlh23 at columbia.edu)
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 25 Issue 9 Pg. 1089-98 (Mar 20 2007) ISSN: 1527-7755 United States
PMID17369572 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Topics
  • African Americans (statistics & numerical data)
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms, Male (ethnology, mortality, pathology, therapy)
  • Chemotherapy, Adjuvant (statistics & numerical data)
  • European Continental Ancestry Group (statistics & numerical data)
  • Follow-Up Studies
  • Humans
  • Kaplan-Meiers Estimate
  • Male
  • Mastectomy (statistics & numerical data)
  • Medicare
  • Neoplasm Staging
  • Odds Ratio
  • Patient Selection
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Radiotherapy, Adjuvant (statistics & numerical data)
  • Referral and Consultation (statistics & numerical data)
  • SEER Program
  • Time Factors
  • Treatment Outcome
  • United States (epidemiology)