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Racial Disparities in Treatment and Survival Among Women With Early-Stage Breast Cancer

From the Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, and the Departments of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; and the Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI

Address reprint requests to Dawn Hershman, MD, MS, New York Presbyterian Hospital, 161 Ft Washington Ave, Rm 1068, New York, NY 10032; e-mail: dlh23{at}columbia.edu

PURPOSE: Black women with breast cancer are known to have poorer survival than white women. Suboptimal treatment may compromise the survival benefits of adjuvant chemotherapy. We analyzed the association of race and survival with duration of treatment and number of treatment cycles among women receiving chemotherapy for early-stage breast cancer.

PATIENTS AND METHODS: Patients were women in the Henry Ford Health System tumor registry who were diagnosed with stage I/II breast cancer between January 1, 1996, and December 31, 2001, who received adjuvant chemotherapy. We calculated an observed/expected ratio of treatment duration and of completed chemotherapy cycles for each patient. Using Cox proportional hazards models, we analyzed the association of early treatment termination and treatment duration with all-cause mortality, controlling for age, race, stage, hormone receptor status, grade, comorbidity score, and doxorubicin use.

RESULTS: Of 472 eligible patients, 28% (31% black, 23% white; P = .03) received fewer cycles of treatment than expected. Black race, receipt of 75% of the expected number of cycles, increasing age, hormone receptor negativity, and a comorbidity score of more than 1 were associated with poorer survival. Among the 344 patients receiving the expected number of cycles, 60% experienced delays. These delays did not reduce survival.

CONCLUSION: This study is the first to find that a substantial fraction of women with early-stage breast cancer terminated their chemotherapy prematurely and that early termination was associated with both black race and poorer survival. A better understanding of the determinants of suboptimal treatment may lead to interventions that can reduce racial disparities and improve breast cancer outcomes for all women.

Supported by the Avon Foundation and the Jean Sindab Fund. Dr Hershman is the recipient of an American Society of Clinical Oncology Career Development Award and a K07 Award from the National Cancer Institute (CA95597). Dr Neugut is the recipient of a K05 Award from the National Cancer Institute (CA89155).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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