Racial differences in the presentation and surgical management of breast cancer

Background. African American women are seen with more advanced breast cance rs, are less likely to be treated with breast-conserving surgery and genera lly have poorer prognoses than white women. There are a myriad of potential causes for these phenomena. The purpose of this study was to measure racia l differences in the surgical treatment of breast cancer among women with c omparable health care access and delivery. Methods. The Breast Cancer Registry of the Department of Surgery at Henry F ord Hospital was accessed for all patients between January 1, 1990, and Dec ember 31, 1997 for whom data on race, tumor characteristics, stage, and tre atment specifics were available. Socioeconomic information was collected wi th use of 1990 census block data. Proportions of women who received each tr eatment weve compared for African Americans and whites with use of the rela tive risk (RR) and 95 % confidence intervals (CI). We used multiple logisti c regression to obtain estimates of the relative risk, controlling for pote ntial confounding factors. Results. Of the 1699 patients in the database, 1250 had sufficient informat ion for analysis. A total of 8.7% of African American women were diagnosed with late-stage disease (ie, stage III or IV) compared with 7.9% of whites. Nevertheless, African American women had a lower frequency of stage I dise ase (30.5% vs 36.2%) and a higher frequency of stage II disease (36.8% vs 3 1.4%). Overall and adjusted risk estimates for age, tumor stage, marital st atus, median income, and type of insurance revealed no substantive or stati stically significant differences between African American and white patient s. The adjusted RR for local excision was 1.39 (95% CI 0.78 to 2.49), for l umpectomy and axillary dissection RR 0.92 (95% CI 0.66 to 1.29), for simple mastectomy RR 0.84 (95% CT 0.41 to 1.72), and for modified radical mastect omy RR 1.00 (95 % CI 0.73 to 1.36). Conclusions. In this setting of equal access to health care, African Americ an women still have higher frequencies of stage II disease, although the fr equencies for late-stage disease are similar: Nevertheless, no surgical dif ferences were found in this population, even after the effects of socioecon omic indicators and stage at diagnosis were controlled for. Survival differ ences between African American and white women are unlikely to be explained by differences in treatment.