Breast Cancer Outcomes in a Racially and Ethnically Diverse Cohort of Insured Women
| Autor: | Reina Haque, Xiaoqing Xu, Rowan T. Chlebowski, Marilyn L. Kwan, Jiaxiao Shi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Oncology
Adult medicine.medical_specialty Epidemiology Breast Neoplasms Metastasis Cohort Studies 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine Outcome Assessment Health Care medicine Ethnicity Humans 030212 general & internal medicine Survivors Stage (cooking) Prospective cohort study Aged Neoplasm Staging Proportional Hazards Models Insurance Health Proportional hazards model business.industry Hazard ratio Cancer General Medicine Middle Aged medicine.disease United States 030220 oncology & carcinogenesis Cohort Female business Original Report: Cancer |
| Popis: | Background: It is unknown how subsequent breast cancer outcomes vary by biologic subtype and race/ethnicity in a diverse cohort of breast cancer survivors. Methods: We conducted a prospective cohort study of 6,154 insured breast cancer survivors (AJCC TNM stages 0–IV) diagnosed between 1996-2007 and followed them through 1/1/2010 for subsequent breast cancer events (recurrence, contralateral breast cancer, metastasis, mortality). We compared subsequent breast cancer rates by race/ethnicity groups and biologic subtype (luminal A, luminal B, HER2-enriched, and triple negative). We calculated hazard ratios (HRs) with 95% CIs using multivariable Cox proportional hazards models, adjusted for sociodemographics, cancer treatments, and tumor characteristics. Results: The cohort was diverse: 62.4% non-Hispanic White, 13.2% Hispanic, 14.9% African American, and 9.5% Asian. We identified 1,456 subsequent breast cancer events over 22,830 person-years. Although certain Asian women had higher crude subsequent breast cancer rates compared with Whites, within each biologic subtype category, these disparities disappeared in the multivariable analyses. After accounting for race/ethnicity, compared with women with luminal A tumors (reference), women with luminal B (adjusted HR=3.65, 95% CI: 3.08-4.32), HER2- enriched (adjusted HR=2.81, 95% CI: 2.25-3.51) and triple negative (adjusted HR=1.25, 95% CI: 1.01-1.54) tumors had statistically increased risks of subsequent breast cancer. Factors that were statistically significantly associated with increased risk included higher stage, larger tumor size, positive lymph nodes, and no adjuvant endocrine or chemotherapy (all P |
| Databáze: | OpenAIRE |
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