Dataset Information

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types.

ABSTRACT:

Importance

Information about stage of cancer at diagnosis, use of therapy, and survival among patients from different racial/ethnic groups with 1 of the most common cancers is lacking.

Objective

To assess stage of cancer at diagnosis, use of therapy, overall survival (OS), and cancer-specific survival (CSS) in patients with cancer from different racial/ethnic groups.

Design, setting, and participants

This cohort study included 950 377 Asian, black, white, and Hispanic patients who were diagnosed with prostate, ovarian, breast, stomach, pancreatic, lung, liver, esophageal, or colorectal cancers from January 2004 to December 2010. Data were collected using the Surveillance, Epidemiology, and End Results (SEER) database, and patients were observed for more than 5 years. Data analysis was conducted in July 2018.

Main outcomes and measures

Multivariable logistic and Cox regression were used to evaluate the differences in stage of cancer at diagnosis, treatment, and survival among patients from different racial/ethnic groups.

Results

A total of 950 377 patients (499 070 [52.5%] men) were included in the study, with 681 251 white patients (71.7%; mean [SD] age, 65 [12] years), 116 015 black patients (12.2%; mean [SD] age, 62 [12] years), 65 718 Asian patients (6.9%; mean [SD] age, 63 [13] years), and 87 393 Hispanic patients (9.2%; mean [SD] age, 61 [13] years). Compared with Asian patients, black patients were more likely to have metastatic disease at diagnosis (odds ratio [OR], 1.144; 95% CI, 1.109-1.180; P < .001). Black and Hispanic patients were less likely to receive definitive treatment than Asian patients (black: adjusted OR, 0.630; 95% CI, 0.609-0.653; P < .001; Hispanic: adjusted OR, 0.751; 95% CI, 0.724-0.780; P < .001). White, black, and Hispanic patients were more likely to have poorer CSS and OS than Asian patients (CSS, white: adjusted HR, 1.310; 95% CI, 1.283-1.338; P < .001; black: adjusted HR, 1.645; 95% CI, 1.605-1.685; P < .001; Hispanic: adjusted HR, 1.300; 95% CI, 1.266-1.334; P < .001; OS, white: adjusted HR, 1.333; 95% CI, 1.310-1.357; P < .001; black: adjusted HR, 1.754; 95% CI, 1.719-1.789; P < .001; Hispanic: adjusted HR, 1.279; 95% CI, 1.269-1.326; P < .001).

Conclusions and relevance

In this study of patients with 1 of 9 leading cancers, stage at diagnosis, treatment, and survival were different by race and ethnicity. These findings may help to optimize treatment and improve outcomes.

SUBMITTER: Zhang C

PROVIDER: S-EPMC7142383 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types.

Zhang Chenyue C Zhang Chenxing C Wang Qingliang Q Li Zhenxiang Z Lin Jiamao J Lin Jiamao J Wang Haiyong H

JAMA network open 20200401 4

<h4>Importance</h4>Information about stage of cancer at diagnosis, use of therapy, and survival among patients from different racial/ethnic groups with 1 of the most common cancers is lacking.<h4>Objective</h4>To assess stage of cancer at diagnosis, use of therapy, overall survival (OS), and cancer-specific survival (CSS) in patients with cancer from different racial/ethnic groups.<h4>Design, setting, and participants</h4>This cohort study included 950 377 Asian, black, white, and Hispanic patie ...[more]

PMID: 32267515

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Project description:ImportanceMany multimodality treatment regimens exist for gastric adenocarcinoma, including neoadjuvant vs adjuvant chemotherapy, radiation, or both. Neoadjuvant therapy is recommended in the United States for patients with locally advanced gastric cancer; however, it is unknown whether the outcomes of neoadjuvant therapy are associated with race and ethnicity.ObjectiveTo evaluate the differences in outcomes by race and ethnicity of patients with noncardia gastric cancer undergoing surgical procedures with and without neoadjuvant therapy.Design, setting, and participantsThis retrospective cohort study examined the National Cancer Database from the American College of Surgeons for patients with clinical stage II or III gastric adenocarcinoma, excluding gastric cardia tumors, undergoing surgical resection procedures from January 2006 to December 2019. Statistical analysis was performed from December 2021 to May 2023.ExposurePatients were stratified by race and ethnicity, and their outcomes were analyzed for those who received and did not receive neoadjuvant therapy.Main outcomes and measuresThe Cox proportional hazard model was used to compare overall survival (OS) between racial and ethnic groups (Asian, Black, Hispanic, and White) overall and according to receipt of neoadjuvant therapy. Among those who received neoadjuvant therapy, proportional differences in pathological responses were calculated in each group.ResultsAmong a total of 6938 patients in the cohort, 4266 (61.4%) were male; mean (SD) age was 65.9 (12.8) years; 1046 (15.8%) were Asian, 1606 (24.3%) were Black, 1175 (17.8%) were Hispanic, and 3540 (53.6%) were White. Compared with other races and ethnicities, the group of White patients had significantly more who were 65 years or older with more comorbidities. White patients underwent surgical resection procedures alone without neoadjuvant or adjuvant therapy more frequently than other races and ethnicities. Asian and Black patients had the highest proportion of being downstaged or achieving pathological complete response after neoadjuvant therapy. In multivariate models, perioperative chemotherapy was associated with improved OS (HR, 0.79 [95% CI, 0.69-0.90]), whereas number of positive lymph nodes and surgical margins were associated with the largest decreases in OS. Asian and Hispanic race and ethnicity were associated with significantly improved OS compared with Black and White races (eg, Asian patients: HR, 0.64 [95% CI, 0.58-0.72]; and Hispanic patients: HR, 0.77 [95% CI, 0.69-0.85]). Black race was associated with improved OS compared with White race when receiving neoadjuvant therapy (HR, 0.78 [95% CI, 0.67-0.90]).Conclusions and relevanceIn this large nationwide cohort study of survival outcomes among patients with resected clinical stage II or III gastric cancer, there were significant differences in response to treatment and OS between different racial and ethnic groups.

Project description:ImportanceAdvanced-stage breast cancer rates vary by race and ethnicity, with Black women having a 2-fold higher rate than White women among regular screeners. Clinical risk factors that explain a large proportion of advanced breast cancers by race and ethnicity are unknown.ObjectiveTo evaluate the population attributable risk proportions (PARPs) for advanced-stage breast cancer (prognostic pathologic stage IIA or higher) associated with clinical risk factors among routinely screened premenopausal and postmenopausal women by race and ethnicity.Design, setting, and participantsThis cohort study used data collected prospectively from Breast Cancer Surveillance Consortium community-based breast imaging facilities from January 2005 to June 2018. Participants were women aged 40 to 74 years undergoing 3 331 740 annual (prior screening within 11-18 months) or biennial (prior screening within 19-30 months) screening mammograms associated with 1815 advanced breast cancers diagnosed within 2 years of screening examinations. Data analysis was performed from September 2022 to August 2023.ExposuresHeterogeneously or extremely dense breasts, first-degree family history of breast cancer, overweight/obesity (body mass index >25.0), history of benign breast biopsy, and screening interval (biennial vs annual) stratified by menopausal status and race and ethnicity (Asian or Pacific Islander, Black, Hispanic/Latinx, White, other/multiracial).Main outcomes and measuresPARPs for advanced breast cancer.ResultsAmong 904 615 women, median (IQR) age was 57 (50-64) years. Of the 3 331 740 annual or biennial screening mammograms, 10.8% were for Asian or Pacific Islander women; 9.5% were for Black women; 5.3% were for Hispanic/Latinx women; 72.0% were for White women; and 2.0% were for women of other races and ethnicities, including those who were Alaska Native, American Indian, 2 or more reported races, or other. Body mass index PARPs were larger for postmenopausal vs premenopausal women (30% vs 22%) and highest for postmenopausal Black (38.6%; 95% CI, 32.0%-44.8%) and Hispanic/Latinx women (31.8%; 95% CI, 25.3%-38.0%) and premenopausal Black women (30.3%; 95% CI, 17.7%-42.0%), with overall prevalence of having overweight/obesity highest in premenopausal Black (84.4%) and postmenopausal Black (85.1%) and Hispanic/Latinx women (72.4%). Breast density PARPs were larger for premenopausal vs postmenopausal women (37% vs 24%, respectively) and highest among premenopausal Asian or Pacific Islander (46.6%; 95% CI, 37.9%-54.4%) and White women (39.8%; 95% CI, 31.7%-47.3%) whose prevalence of dense breasts was high (62%-79%). For premenopausal and postmenopausal women, PARPs were small for family history of breast cancer (5%-8%), history of breast biopsy (7%-12%), and screening interval (2.1%-2.3%).Conclusions and relevanceIn this cohort study among routinely screened women, the proportion of advanced breast cancers attributed to biennial vs annual screening was small. To reduce the number of advanced breast cancer diagnoses, primary prevention should focus on interventions that shift patients with overweight and obesity to normal weight.

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Dataset Information

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types.

Similar Datasets

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