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Racial Disparities in Treatment and Survival of Male Breast Cancer

Katherine D. Crew, Alfred I. Neugut, Xiaoyan Wang, Judith S. Jacobson, Victor R. Grann, George Raptis, Dawn L. Hershman

From the Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons; and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY

Address reprint requests to Dawn L. Hershman, MD, MS, Columbia University, 161 Fort Washington Ave, 10-1068, New York, NY 10032; e-mail: dlh23{at}columbia.edu

Purpose 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.

Supported by a National Cancer Institute (NCI) -funded postdoctoral fellowship (T32-CA09529) to K.D.C., a K05 Award (CA89155) and an American Cancer Society grant (RSGT-01-02404-CPHPS) to A.I.N., an American Cancer Society Award (CRTG-98-260-01) to V.R.G., and an K07 Award from the NCI (CA95597) to D.L.H.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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