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Allard JE, Chandramouli GVR, Stagliano K, Hood BL, Litzi T, Shoji Y, Boyd J, Berchuck A, Conrads TP, Maxwell GL, Risinger JI. Analysis of PSPHL as a Candidate Gene Influencing the Racial Disparity in Endometrial Cancer. Front Oncol 2012; 2:65. [PMID: 22783543 PMCID: PMC3389395 DOI: 10.3389/fonc.2012.00065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/04/2012] [Indexed: 11/13/2022] Open
Abstract
Endometrial cancer is the most commonly diagnosed gynecologic malignancy in the United States. A well recognized disparity by race in both incidence and survival outcome exists for this cancer. Specifically Caucasians are about two times more likely to develop endometrial cancer than are African-Americans. However, African-American women are more likely to die from this disease than are Caucasians. The basis for this disparity remains unknown. Previous studies have identified differences in the types and frequencies of gene mutations among endometrial cancers from Caucasians and African-Americans suggesting that the tumors from these two groups might have differing underlying genetic defects. We performed a gene expression microarray study in an effort to identify differentially expressed transcripts between African-American and Caucasian women's endometrial cancers. Our gene expression screen identified a list of potential biomarkers that are differentially expressed between these two groups of cancers. Of these we identified a poorly characterized transcript with a region of homology to phospho serine phosphatase (PSPH) and designated phospho serine phosphatase like (PSPHL) as the most differentially over-expressed gene in cancers from African-Americans. We further clarified the nature of expressed transcripts. Northern blot analysis confirmed the message was limited to a transcript of under 1 kB. Sequence analysis of transcripts confirmed two alternate open reading frame (ORF) isoforms due to alternative splicing events. Splice specific primer sets confirmed both isoforms were differentially expressed in tissues from Caucasians and African-Americans. We further examined the expression in other tissues from women to include normal endometrium, normal and malignant ovary. In all cases PSPHL expression was more often present in tissues from African-Americans than Caucasians. Our data confirm the African-American based expression of the PSPHL transcript in endometrial cancer and also identify its expression in other tissues from African-Americans including ovary and ovarian cancer. PSPHL represents a candidate gene that might influence the observed racial disparity in endometrial and other cancers.
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Affiliation(s)
- Jay E Allard
- Walter Reed Army Medical Center Washington, DC, USA
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Oliver KE, Enewold LR, Zhu K, Conrads TP, Rose GS, Maxwell GL, Farley JH. Racial disparities in histopathologic characteristics of uterine cancer are present in older, not younger blacks in an equal-access environment. Gynecol Oncol 2011; 123:76-81. [PMID: 21741078 DOI: 10.1016/j.ygyno.2011.06.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/15/2011] [Accepted: 06/20/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to determine whether racial disparities in tumor characteristics among uterine cancer patients persisted, and varied by age, in an equal-access healthcare population. METHODS The distributions of tumor histology, stage and grade by race were compared for uterine cancers diagnosed from 1990 to 2003 using data from the U.S. Department of Defense's Automated Central Tumor Registry. Comparisons were conducted overall and stratified by age (<50, ≥50) using the Chi-square test. RESULTS Of 2582 uterine tumors identified, 2057 (79.7%) were diagnosed among White women and 183 (7.1%) among Black women. Among all women analyzed, Blacks were more likely than Whites to present with non-endometrioid tumors (47.7% vs 23.5%, p<0.01), non-localized tumors (31.8% vs 24.5%, p=0.02), and poorly differentiated tumors (20.5% vs 15.0%, p<0.01). Among women 50 years and older, similar significant racial disparities were observed. However, no significant racial differences were observed among young patients. When comparisons were restricted to endometrioid histology adenocarcinomas, trends in age-specific disparities for older women were observed. CONCLUSIONS Our study suggests that racial disparities in uterine cancers persist between Blacks and Whites in an equal-access population. Blacks endure higher stage and grade tumors, and more aggressive histologies. This disparity in clinicopathologic factors is confined to women older than 50 years. Multiple factors such as racial variation in age-related health knowledge/behavior and estrogen metabolism may be related to the racial disparity.
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Affiliation(s)
- Kate E Oliver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Sun M, Abdollah F, Liberman D, Abdo A, Thuret R, Tian Z, Shariat SF, Montorsi F, Perrotte P, Karakiewicz PI. Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors: a survival analysis. Cancer 2011; 117:4277-85. [PMID: 21387261 DOI: 10.1002/cncr.25969] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/18/2010] [Accepted: 12/29/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous reports indicated that African-American men with testicular germ cell tumors (TGCTs) have more aggressive tumor characteristics and less favorable outcomes than other men. The authors of this report evaluated the effects of race and socioeconomic status (SES) on stage distribution, overall mortality (OM), and cancer-specific mortality (CSM) in men with TGCTs. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 22,553 men who were diagnosed with TGCTs between 1988 and 2006. Kaplan-Meier and Cox regression analyses were generated to predict OM and CSM. Covariates of the analyses included race, SES, age, histologic subtype, disease stage, procedure type, SEER registry, and year of diagnosis. The interaction between race and SES also was examined. RESULTS Overall, there were 516 African-American men, 21,090 Caucasian men, and 947 men of other races. African-Americans (14.9%) and individuals with low SES (10.7%) had a higher proportion of distant stage disease. CSM and OM rates were significantly higher for African-American patients and for patients who resided in low SES counties. Multivariate analyses revealed that African-American men and men with low SES were more likely to die of OM and CSM relative to Caucasian men (P < .001) and men with high SES (P < .001), respectively. The interaction between race and SES was not significant. CONCLUSIONS African-American race and low SES appeared to predispose men to more advanced disease stages and to higher OM and CSM rates. These observations may warrant race-specific and/or SES-specific adjustments in the treatment of TGCT.
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Affiliation(s)
- Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
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Sabatino SA, Stewart SL, Wilson RJ. Racial and ethnic variations in the incidence of cancers of the uterine corpus, United States, 2001-2003. J Womens Health (Larchmt) 2009; 18:285-94. [PMID: 19231990 DOI: 10.1089/jwh.2008.1171] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We examined racial/ethnic variations in uterine corpus cancer incidence. METHODS Data are from state cancer registries meeting quality criteria in the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) programs, 2001-2003. We included females with microscopically confirmed invasive uterine corpus cancer (n = 97,098). We calculated age-adjusted incidence rates per 100,000, stratified by race and ethnicity. RESULTS Cancers were most common among women who were 50-64 years old, white and non-Hispanic. Epithelial cancer rates were lower for Asian/Pacific Islanders (API) than whites (12.8 vs. 21.7, p < 0.0001), including serous adenocarcinoma (0.5 vs. 0.9, p < 0.0001). Epithelial cancer rates were also lower for American Indian/Alaska Natives (AIAN) vs. whites (11.5 vs. 21.7, p < 0.0001) and Hispanics vs. non-Hispanics (16.0 vs. 21.3, p < 0.0001). Among all race groups, blacks had the highest rates of mesenchymal (0.9) and mixed cancers (2.0) and of serous adenocarcinoma (2.0), clear cell adenocarcinoma (0.5), and carcinosarcoma (1.9). Blacks also had the lowest rates of low-grade and localized stage epithelial cancer and the highest rates of high-grade and distant stage disease. CONCLUSIONS Uterine corpus cancer rates are generally lower for API and AIAN than for whites or blacks and for Hispanics vs. non-Hispanics. Further research is needed to understand reasons for the differences in incidence.
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Affiliation(s)
- Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Maxwell GL, Tian C, Risinger J, Brown CL, Rose GS, Thigpen JT, Fleming GF, Gallion HH, Brewster WR. Racial disparity in survival among patients with advanced/recurrent endometrial adenocarcinoma: a Gynecologic Oncology Group study. Cancer 2006; 107:2197-205. [PMID: 17001661 DOI: 10.1002/cncr.22232] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies have reported shorter survival of black women compared with white women who had advanced/recurrent endometrial cancer. It has been suggested that this may reflect racially based differences in treatment. METHODS The authors retrospectively reviewed data from 169 black women and 982 white women with International Federation of Gynecologic Oncology (FIGO) Stage III, Stage IV, or recurrent endometrial carcinoma who were participants in 1 of 4 Gynecologic Oncology Group randomized treatment trials of doxorubicin alone or combined with paclitaxel and/or cisplatin. Demographic, histologic, treatment, and outcome data were analyzed to estimate survival, and between-group comparisons were performed. RESULTS The pooled data revealed that black women were more likely to have papillary serous histology (P < .001), Stage IV disease (P < .001), and higher tumor grade (P < .001) compared with white women, and survival was worse among black women than among white women (median survival, 10.6 months vs. 12.2 months, respectively; P < .001). A Cox proportional hazards regression analysis that was adjusted for performance status, disease stage, tumor histology, tumor grade, and treatment demonstrated worse survival for black women (hazards ratio, 1.26, 95% confidence interval, 1.06-1.51; P = .010). CONCLUSIONS The data from a large group of women with advanced/recurrent endometrial cancer suggested that a racial disparity in survival persists, despite the finding that black women and white women received similar treatment. Although the causes of racial disparity in endometrial cancer remain to be elucidated, socioeconomic, biologic, and cultural factors should be investigated to identify the etiologic origins of this multifactorial healthcare problem.
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Affiliation(s)
- G Larry Maxwell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and the U.S. Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC, USA
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Cook LS, Kmet LM, Magliocco AM, Weiss NS. Endometrial cancer survival among U.S. black and white women by birth cohort. Epidemiology 2006; 17:469-72. [PMID: 16755263 DOI: 10.1097/01.ede.0000221026.49643.cf] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endometrial cancer incidence is lower but mortality is higher among black relative to white women. This disparity results from a relatively higher level of case-fatality in African Americans. We investigated whether the inter-racial difference in survival has diminished in more recent birth cohorts. METHODS Women diagnosed with endometrial malignancies during 1977-1996 were identified from the U.S. Surveillance, Epidemiology and End Results program (45,261 white and 1986 black women). We calculated cumulative 5-year relative survival for 6 birth cohorts. RESULTS Survival was relatively higher in younger women than older women and in women diagnosed in earlier years compared with more recent years. Higher survival was evident in more recent birth cohorts for groups of women 60+ years of age and in all time periods, particularly for black women. CONCLUSIONS Although black women with endometrial cancer have a poorer prognosis than white women, the inter-racial difference in survival has narrowed in more recent birth cohorts.
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Affiliation(s)
- Linda S Cook
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Ueda K, Kawachi I, Tsukuma H. Cervical and corpus cancer survival disparities by socioeconomic status in a metropolitan area of Japan. Cancer Sci 2006; 97:283-91. [PMID: 16630120 PMCID: PMC11158084 DOI: 10.1111/j.1349-7006.2006.00179.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to analyze socioeconomic differences in cervical and corpus cancer survival, and to investigate if the differences are due to differences in age, cancer stage, histology and treatment. A total of 14,055 cases with cervical cancer and 3,113 cases with corpus cancer were obtained from the Osaka Cancer Registry. Municipality-based SES measurements were obtained from the System of Social and Demographic Statistics. Survival analysis was carried out with Kaplan-Meier survival curves. Three types of Cox proportional hazards regression models were tested to assess survival differences among groups and effects of SES on survival, controlling for clinical factors. SES was related to age and cancer stage for cervical and corpus cancer patients, and histology for cervical cancer patients. Differences were observed in cumulative 5-year survival for cervical cancer patients among low, middle and high unemployment municipalities (68.9%, 64.3% and 50.9%, respectively, P<0.0001). Differences in cumulative 5-year survival for cervical cancer patients were also observed among high, middle and low education municipalities (65.1%, 62.2% and 56.1%, respectively, P<0.0001). Similar patterns in 5-year survival were also found for corpus cancer patients. After adjusting for age, cancer stage, histology and treatment, survival differences between patients from high and low SES areas still remained. In conclusion, our population-based analysis of a metropolitan representative sample in Japan has demonstrated, for the first time in Japan, SES differences in survival following cervical and corpus cancer.
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Affiliation(s)
- Kimiko Ueda
- Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. kueda@xb4,so-net.ne.jp
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Miller JAG, Rege RV, Ko CY, Livingston EH. Health care access and poverty do not explain the higher esophageal cancer mortality in African Americans. Am J Surg 2004; 188:22-6. [PMID: 15219480 DOI: 10.1016/j.amjsurg.2003.12.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2003] [Revised: 12/22/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND Esophageal cancer mortality is increased in African Americans relative to white patients. The reasons for this are unknown but are thought to be related to inadequate access to health care secondary to a higher poverty rate in African American populations. METHODS The National Health Interview Survey database for years 1986 to 1994 were combined and linked to the National Death Index. Individuals who died from esophageal carcinoma were assessed in the combined database, thus enabling detailed analysis of their socioeconomic status, race, and health care access. RESULTS Poverty was 4-fold more frequent in African Americans who died from esophageal carcinoma than whites. Despite poverty, African American patients' access to health care was good and was not statistically related to increased mortality. CONCLUSIONS Although the esophageal carcinoma mortality rate is higher in African Americans than in whites, it is not clearly related to the presence of poverty or to limited health care access. The higher mortality may be related to lifestyle differences, environmental exposure, or difference in disease biology, but it is not related exclusively to socioeconomic factors.
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Affiliation(s)
- Jordan A G Miller
- Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern School of Medicine, 5323 Harry Hines Blvd., Room E7-126, Dallas, TX 75390-9156, USA
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Cronjé HS, Fourie S, Doman MJ, Helms JB, Nel JT, Goedhals L. Racial differences in patients with adenocarcinoma of the endometrium. Int J Gynaecol Obstet 2004; 39:213-8. [PMID: 1360916 DOI: 10.1016/0020-7292(92)90659-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the differences between white and black women with regard to the presentation and behavior of adenocarcinoma of the endometrium. METHOD Records of 273 (68%) white patients and 117 (32%) black patients with endometrial adenocarcinoma were reviewed in Bloemfontein, South Africa. Survival data was calculated according to the direct method where losses in follow-up were regarded as tumor deaths. RESULTS Most patients (82%) were treated by pre-operative radium followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy, with post-operative external irradiation where indicated. Pre-operatively, fewer black women had reached FIGO stage I, while a larger number had advanced to stages II-IV (P = 0.0024). In addition, the tumor differentiation was more often poor in the black group (P < 0.0001). Ten-year follow-up was achieved in 84% of the white patients and 51% of the black patients and the 10-year survival figures were 67% for white patients and 28% for blacks (P < 0.0001). CONCLUSION Endometrial adenocarcinoma is a more aggressive disease in black women than it is in whites.
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Affiliation(s)
- H S Cronjé
- Gynecologic Oncology Group, University of the Orange Free State, Bloemfontein, South Africa
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Madeb R, Messing EM. Gender, racial and age differences in bladder cancer incidence and mortality. Urol Oncol 2004; 22:86-92. [PMID: 15082003 DOI: 10.1016/s1078-1439(03)00139-x] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Revised: 08/12/2003] [Accepted: 08/20/2003] [Indexed: 12/13/2022]
Abstract
Bladder cancer is the fourth most commonly diagnosed cancer in men and the eighth most common in women in the United States. While clinicians who diagnose and treat the disease recognize that bladder cancer has a unique demographic profile, the influence of such factors as age, gender and race on incidence, prognosis, and survival of patients is poorly understood, and has not been the subject of intense investigation. Both through analysis of the population-based databases of bladder cancer in the United States and Europe, as well as epidemiological studies, some of the effects of gender, race and age on this disease have begun to be explained. In this manuscript we review the current literature and epidemiological studies on the affects of gender, race and age on incidence and mortality of bladder cancer.
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Affiliation(s)
- Ralph Madeb
- Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, NY, USA
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Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer 2003; 98:176-86. [PMID: 12833470 DOI: 10.1002/cncr.11484] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the United States, incidence rates for malignant tumors of the uterine corpus are lower among blacks than among whites, whereas mortality rates are higher among blacks. Reasons for the higher level of mortality among blacks have been debated. METHODS Using data from the Surveillance, Epidemiology, and End Results program, the authors compared incidence rates by histopathologic type for malignant tumors of the uterine corpus (including uterus, not otherwise specified) during the period 1992-1998 among white Hispanic, black, and white non-Hispanic patients. The authors also compared cumulative relative survival rates for blacks and whites by histopathologic type and by other factors, and they calculated estimated type-specific mortality rates. RESULTS Overall incidence (per 100,000 woman-years) of corpus malignancy was significantly lower among white Hispanics (14.04; 95% confidence interval [CI], 13.39-14.72) and blacks (15.31; 95% CI, 14.61-16.04) compared with white non-Hispanics (23.43; 95% CI, 23.06-23.81). Compared with white non-Hispanics, blacks had significantly higher incidence rates of serous/clear cell carcinoma (rate ratio, 1.85; 95% CI, 1.61-2.12), carcinosarcoma (rate ratio, 2.33; 95% CI, 1.99-2.72), and sarcoma (rate ratio, 1.56; 95% CI, 1.31-1.86). Survival was worse for blacks than for whites in every histopathologic category and in 'usual' types of endometrial adenocarcinoma, stratified by stage, grade, and age. Rare aggressive tumor types accounted for 53% of mortality among blacks, compared with 36% among whites. CONCLUSIONS Less favorable outcomes for usual types of endometrial adenocarcinoma and for rare aggressive tumors contribute equally to the relatively high mortality due to corpus cancer among black women.
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Affiliation(s)
- Mark E Sherman
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Bethesda, Maryland 20892, USA.
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Govindarajan R, Shah RV, Erkman LG, Hutchins LF. Racial differences in the outcome of patients with colorectal carcinoma. Cancer 2003; 97:493-8. [PMID: 12518374 DOI: 10.1002/cncr.11067] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND African-American (AA) patients with colorectal carcinoma have a worse prognosis compared with Caucasians. To analyze the causes of this disparity in survival, a retrospective study of patients with colorectal carcinoma was undertaken. The impact of treatments received and the role of socioeconomic factors such as income, education, and poverty levels were studied. METHODS A retrospective analysis of patients with colorectal carcinoma at a single institution was conducted. The overall survival of AA and Caucasians, stage at presentation, treatment received, and socioeconomic factors were analyzed using the institutional tumor registry and 1990 census data. RESULTS The overall survival of AA patients was worse compared with Caucasians, both due to all causes (P < 0.001) and cancer-related deaths (P < 0.001). The relative risk of death due to all causes was 1.4 (95% confidence interval [CI] 1.2-1.8) for AA, 4.3 for patients with Stage IV disease (95% CI 3.2-5.7), and 2.3 for patients not undergoing surgery (95% CI 1.7-3.1). After multivariate adjustment for gender, site, socioeconomic factors, and therapeutic modalities, the relative risks for death were 1.5 (95% CI 1.2) for AA, 1.4 (95% CI 1.1-1.7) for patients 60 years of age or older, and 4.2 (95% CI 3.4-5.2) for Stage IV disease. The survival difference between AA and Caucasians was not influenced by income, poverty level, and education. African Americans were treated less frequently with chemotherapy and radiation therapy compared with their Caucasian counterparts. CONCLUSIONS African American patients with colorectal carcinoma have a poorer prognosis compared with Caucasians. This discrepancy may be due to decreased utilization of chemotherapy and radiation therapy. Socioeconomic factors and lack of access to health care do not entirely explain the worse prognosis of AA. These factors should be identified and dealt with to improve the health care of AA patients with various malignant disorders.
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Affiliation(s)
- Rangaswamy Govindarajan
- Division of Hematology/Oncology, Department of Internal Medicine, University of Arkansas for Medical Sciences and Arkansas Cancer Research Center, Little Rock, Arkansas 72205, USA.
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Dominitz JA, Maynard C, Billingsley KG, Boyko EJ. Race, treatment, and survival of veterans with cancer of the distal esophagus and gastric cardia. Med Care 2002; 40:I14-26. [PMID: 11789626 DOI: 10.1097/00005650-200201001-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Prior studies have found racial differences in the use of invasive procedures and in cancer survival. OBJECTIVE To assess the influence of race on the treatment and survival of patients with distal esophageal cancer. DESIGN Retrospective cohort study. SETTING All Veterans Affairs Medical Centers. PATIENTS One thousand two hundred ninety white and 231 black male veterans with a new diagnosis of distal esophageal cancer during 1993 to 1997. MAIN OUTCOME MEASURES Utilization of surgical resection, chemotherapy, radiation therapy, and survival. RESULTS Black patients with esophageal adenocarcinoma were less likely to undergo surgery (OR, 0.54; 95% CI, 0.30-0.96) but had similar odds of undergoing chemotherapy and radiation therapy. Black patients with squamous cell carcinoma (SCC) were less likely to undergo surgical resection (OR, 0.45; 95% CI, 0.29-0.70), but were more likely to undergo radiation therapy (OR, 1.72; 95% CI, 1.21-2.47) and chemotherapy (OR, 1.74; 95% CI, 1.19-2.54). Mortality was increased for black patients with SCC (adjusted risk ratio 1.33; 95% CI, 1.10-1.61) but not adenocarcinoma. Among those veterans who underwent surgical resection (n = 502), similar results were found. CONCLUSIONS Black veterans with distal SCC are less likely than white veterans to undergo surgical resection, whereas the use of radiation therapy and chemotherapy, as well as mortality, is increased. Black patients with distal esophageal adenocarcinoma have lower odds of undergoing surgical resection but have similar utilization of radiation therapy and chemotherapy and similar survival. Despite the presence of an equal access medical system, treatment and outcomes differ for black and white veterans with distal esophageal cancer.
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Affiliation(s)
- Jason A Dominitz
- Seattle Epidemiologic Research and Information Center, Department of Surgery, VA Puget Sound Health Care System, Washington 98108-1597, USA.
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Race and Clinical Outcome in Endometrial Carcinoma. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199911000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Boyd C, Zhang-Salomons JY, Groome PA, Mackillop WJ. Associations between community income and cancer survival in Ontario, Canada, and the United States. J Clin Oncol 1999; 17:2244-55. [PMID: 10561282 DOI: 10.1200/jco.1999.17.7.2244] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The objectives of this study were as follows: (1) to compare the magnitude of the association between socioeconomic status (SES) and cancer survival in the Canadian province of Ontario with that in the United States (U.S.), and (2) to compare cancer survival in communities with similar SES in Ontario and in the U.S. METHODS The Ontario Cancer Registry provided information about all cases of invasive cancer diagnosed in Ontario from 1987 to 1992, and the Surveillance, Epidemiology and End Results Registry (SEER) provided information about all cases diagnosed in the SEER regions of the U.S. during the same time period. Census data provided information about SES at the community level. The product-limit method was used to describe cause-specific survival. Cox proportional hazards models were used to describe the association between SES and the risk of death from cancer. RESULTS There were significant associations between SES and survival for most cancer sites in both the U.S. and Ontario, but the magnitude of the association was usually larger in the U.S. In the poorest communities, there were significant survival advantages in favor of cancer patients in Ontario for many disease groups, including cancers of the lung, head and neck region, cervix, and uterus. However, in upper- and middle-income communities, there were significant survival advantages in favor of the U.S. for all cases combined and for several individual diseases, including cancers of the breast, colon and rectum, prostate, and bladder. CONCLUSION The association between SES and cancer survival is weaker in Ontario than it is in the U.S. This is due to a combination of better survival among patients in the poorest communities and worse survival among patients in the wealthier communities of Ontario relative to those in the U.S.
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Affiliation(s)
- C Boyd
- The Radiation Oncology Research Unit and Departments of Oncology and Community Health and Epidemiology, Queen's University, Kingston Regional Cancer Centre, Kingston, Ontario, Canada
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Dominitz JA, Samsa GP, Landsman P, Provenzale D. Race, treatment, and survival among colorectal carcinoma patients in an equal-access medical system. Cancer 1998; 82:2312-20. [PMID: 9635522 DOI: 10.1002/(sici)1097-0142(19980615)82:12<2312::aid-cncr3>3.0.co;2-u] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this study was to assess the influence of race on the treatment and survival of patients with colorectal carcinoma. METHODS This retrospective cohort study included all white or black male veterans given a new diagnosis of colorectal carcinoma in 1989 at Veterans Affairs Medical Centers nationwide. After adjusting for patient demographics, comorbidity, distant metastases, and tumor location, the authors determined the likelihood of surgical resection, chemotherapy, radiation therapy, and death in each case. RESULTS Of the 3176 veterans identified, 569 (17.9%) were black. Bivariate analyses and logistic regression revealed no significant differences in the proportions of patients undergoing surgical resection (70% vs. 73%, odds ratio 0.92, 95% confidence interval 0.74-1.15), chemotherapy (23% vs. 23%, odds ratio 0.99, 95% confidence interval 0.78-1.24), or radiation therapy (17% vs. 16%, odds ratio 1.10, 95% confidence interval 0.85-1.43) for black versus white patients. Five-year relative survival rates were similar for black and white patients (42% vs. 39%, respectively; P=0.16), though the adjusted mortality risk ratio was modestly increased (risk ratio 1.13, 95% confidence interval 1.01-1.28). CONCLUSIONS Overall, race was not associated with the use of surgery, chemotherapy, or radiation therapy in the treatment of colorectal carcinoma among veterans seeking health care at Veterans Affairs Medical Centers. Although mortality from all causes was higher among black veterans with colorectal carcinoma, this finding may be attributed to underlying racial differences associated with survival. This study suggests that when there is equal access to care, there are no differences with regard to race.
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Affiliation(s)
- J A Dominitz
- Center for Health Services Research and Development, Veterans Affairs Medical Center, Durham, North Carolina, USA
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17
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Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Moskowitz A, Webster DJ, Richter NL. An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas. Am J Public Health 1997; 87:1156-63. [PMID: 9240106 PMCID: PMC1380890 DOI: 10.2105/ajph.87.7.1156] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States. METHODS The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses. RESULTS In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups. CONCLUSIONS The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canada's more equitable access to preventive and therapeutic health care services is responsible for the difference.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada
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Clifford SL, Kaminetsky CP, Cirisano FD, Dodge R, Soper JT, Clarke-Pearson DL, Berchuck A. Racial disparity in overexpression of the p53 tumor suppressor gene in stage I endometrial cancer. Am J Obstet Gynecol 1997; 176:S229-32. [PMID: 9215213 DOI: 10.1016/s0002-9378(97)70380-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study was conducted to determine whether overexpression of the p53 tumor suppressor gene is associated with poor outcome in early-stage endometrial cancers and whether a racial difference in the frequency of p53 overexpression contributes to the observed racial disparity in survival rates. STUDY DESIGN Immunostaining for the p53 gene was performed in 164 women with stage I endometrial adenocarcinomas. RESULTS Overexpression of mutant p53 protein was seen in 28 out of 164 (17%) cases and was associated with a poor histologic grade (p = 0.003) and a nonendometrioid histologic appearance (p = 0.06). Overexpression also was three times more frequent in blacks (15 out of 44, 34%) than in whites (13 out of 117, 11%) (p = 0.003). Recurrent disease developed in 15 out of 164 (9%) cases and was more than twice as frequent in cases when the p53 gene was overexpressed (5 out of 28, 18%) than in cases with normal expression (10 out of 136, 7%). Recurrent disease was seen in 6 out of 44 (14%) blacks compared to 9 out of 117 (8%) whites. CONCLUSIONS These data support the hypothesis that differences in the frequency of alteration of the p53 tumor suppressor gene contribute to the racial disparity in endometrial cancer survival.
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Affiliation(s)
- S L Clifford
- Department of Obstetrics and Gynecology/Division of Gynecologic Oncology, Duke University Comprehensive Cancer Center, Duke University Medical Center, Durham, NC 27710, USA
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19
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Plaxe SC, Saltzstein SL. Impact of ethnicity on the incidence of high-risk endometrial carcinoma. Gynecol Oncol 1997; 65:8-12. [PMID: 9103384 DOI: 10.1006/gyno.1996.4594] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the impact of race/ethnicity on histology in endometrial cancer. METHODS California Cancer Registry data on 11,674 white and 423 black women with endometrial cancer registered from 1988 to 1992 were used to compare the average annual age-adjusted incidence rate/100,000 women of low-risk (grades 1 and 2 endometrioid adenocarcinoma) and high-risk (grade >2 endometrioid carcinomas, papillary serous, clear cell, and adenosquamous histologies) lesions in black and white women. RESULTS Of the white patients, 9059 (78%) had low-risk and 2615 (22%) had high-risk lesions. Of the black patients, 236 (56%) had low-risk and 187 (44%) had high-risk lesions. The overall average annual age-adjusted incidence of endometrial cancer in white women is 20.1/100,000 and for black women is 9.4/100,000; however, the incidence of low-risk tumors is 15.9/100,000 in white women and only 5.3/100,000 in black women. The incidence of high-risk disease is identical in black and white women (4.2/100,000). CONCLUSIONS Black women in the general population have the same likelihood as white women of developing high-risk endometrial cancer. Black women have a significantly lower incidence of low-risk tumors compared to white women. The increased incidence of low-grade lesions in white women may be due to differences in socioeconomic factors or other factors yet to be identified.
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Affiliation(s)
- S C Plaxe
- Department of Reproductive Medicine, University of California at San Diego, La Jolla 92103, USA
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20
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Franzini L, Williams AF, Franklin J, Singletary SE, Theriault RL. Effects of race and socioeconomic status on survival of 1,332 black, Hispanic, and white women with breast cancer. Ann Surg Oncol 1997; 4:111-8. [PMID: 9084846 DOI: 10.1007/bf02303792] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A survival disadvantage for black women with breast cancer, which persists after controlling for stage of the disease, has been reported. This study investigates the effects of race and socioeconomic status (SES) on breast cancer survival after controlling for age, stage, histology, and type of treatment. METHODS Kaplan-Meier and Cox proportional hazards models were used to analyze the interaction between race and SES in predicting survival in a sample of 163 black, 205 Hispanic and 964 white women with breast cancer treated at M.D. Anderson Cancer Center a (1987-1991). RESULTS The results of univariate and multivariate analyses indicate that race was not a significant predictor of survival after adjusting for SES and other confounding factors such as demographic and disease characteristics. SES remained a significant predictor of survival after all adjustments were made. There was no evidence of differences in type of treatment by race or SES if adjustments were made for stage. CONCLUSIONS These results suggest that institutional factors, such as access to treatment, do not explain survival differences by race or SES. Other factors associated with low SES, such as life-style and behavior, may affect survival.
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Affiliation(s)
- L Franzini
- Health Policy Institute, University of Texas School of Public Health, Houston 77030, USA
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21
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Greenwald HP, Polissar NL, Dayal HH. Race, socioeconomic status and survival in three female cancers. ETHNICITY & HEALTH 1996; 1:65-75. [PMID: 9395549 DOI: 10.1080/13557858.1996.9961771] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Although many studies have reported that socioeconomic status (SES) and race affect cancer survival, researchers have not established whether SES and race affect survival independently. The research reported here addresses this question with special attention to cancers affecting large numbers of women in the US. METHODS The authors analyzed data on survival among patients in the Centralized Cancer Patient Data System (CCPDS) with cancers of the breast (n = 6896), cervix (n = 2209) and uterine corpus (n = 1492). RESULTS According to Cox proportional hazards models, race predicted survival in all three cancers, while socioeconomic status predicted survival for cancers of the breast and uterine corpus. Interaction effects between race and SES were generally not statistically significant. This study includes larger numbers of observations within specific forms of cancer and covers a broader patient population than most previous investigations. These features promote detectability of SES effects, comparability among disease sites, and generalizability to cancer patients throughout the US. CONCLUSIONS Findings imply that SES and race affect cancer mortality risk independently of each other, and that the impact of SES and race may vary by malignancy. Survival disadvantages due to race-which may be more pronounced among women than men-should remain a continuing concern.
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Affiliation(s)
- H P Greenwald
- University of Southern California, University Park, Los Angeles 90089, USA
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22
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Fein O. The influence of social class on health status: American and British research on health inequalities. J Gen Intern Med 1995; 10:577-86. [PMID: 8576775 DOI: 10.1007/bf02640369] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To summarize recent and past American and British studies on the relationship of social class and health status. DATA SOURCES A systematic review of the pertinent British and American literature, including references identified from bibliographies of books and recent articles. STUDY SELECTION Published English-language studies that report original or summary data describing socioeconomic status and mortality/morbidity are emphasized. DATA SYNTHESIS Social class, whether measured by occupation, income, or education, has a marked effect on mortality and morbidity. Use of British and American standardized mortality ratios (SMRs) shows that the gap between the advantaged upper socioeconomic classes and the disadvantaged lower classes has become wider from 1930 to 1980. Explanations for this inequality in health status by socioeconomic status point to four factors: artefact, social selection, culture/behavior, and material/structural conditions. A synthesis of existing literature suggests that material deprivation and social deprivation are the most important factors contributing to this association, although data from longitudinal studies implicate social hierarchy. CONCLUSION The reviewed studies point to growing inequalities in health status between those of lower and those of higher socioeconomic status. Clinicians and teachers in internal medicine should incorporate this knowledge in assessing patients and adopt a perspective that takes account of socioeconomic factors in diagnostic and management decisions.
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Affiliation(s)
- O Fein
- Cornell University Medical College, New York, New York 10021, USA
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Barrett RJ, Harlan LC, Wesley MN, Hill HA, Chen VW, Clayton LA, Kotz HL, Eley JW, Robboy SJ, Edwards BK. Endometrial cancer: stage at diagnosis and associated factors in black and white patients. Am J Obstet Gynecol 1995; 173:414-22; discussion 422-3. [PMID: 7645616 DOI: 10.1016/0002-9378(95)90261-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study examined the relationship of clinicopathologic, health status, medical system, and socioeconomic factors to differences in stage at diagnosis of endometrial cancer in black and white patients. STUDY DESIGN A population-based study of 130 black and 329 white patients with invasive endometrial cancer was conducted as part of the National Cancer Institute's Black/White Cancer Survival Study. Logistic regression was used to determine the relative importance of factors thought to be related to stage at diagnosis after age and geographic location were adjusted for. RESULTS High-grade (poorly differentiated) lesions increased the risk for stage III or IV disease (odds ratio 8.3, 95% confidence interval 3.4 to 20.3), as did serous histologic subtype (odds ratio 3.5, 95% confidence interval 1.4 to 8.8) and no usual source of care (odds ratio 5.5, 95% confidence interval 1.4 to 20.9). In the final statistical model these three factors also accounted for the majority of the excess risk of advanced stage for blacks. CONCLUSIONS Black-white racial disparities in stage at diagnosis appear to be related to higher-grade lesions and more aggressive histologic subtypes occurring more frequently in black patients with endometrial cancer.
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Affiliation(s)
- R J Barrett
- Department of Obstetrics and Gynecology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC, USA
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Aziz H, Rotman M, Hussain F, Smith G, Chan E, Choi K, Sohn C, Halpern J, Schwartz D, Aral I. Poor survival of black patients in carcinoma of the endometrium. Int J Radiat Oncol Biol Phys 1993; 27:293-301. [PMID: 8407403 DOI: 10.1016/0360-3016(93)90240-v] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare the prognostic factors and survivals of black and white patients with endometrial carcinoma. METHODS AND MATERIALS A retrospective study was undertaken of a total of 290 patients with endometrial carcinoma who were treated similarly at the Health Science Center at Brooklyn and Kings County Hospital Center from 1975 and 1990. One hundred and thirty-six of 290 (47.2%) were black and 135/290 (46.9%) were white. Well-known prognostic factors affecting endometrial carcinoma were studied in black and white group of patients. Their overall survival and comparison of survival in each prognostic group were also estimated using multi-variate analysis. RESULTS Fifty-four percent of white patients had Stage I disease, compared to 45.9% in black patients. In Stage II, 51.6% were white and 48.4% were black, and in Stage III, 88.89% were black and 11.1% were white patients (p = 0.034). Fifty six percent Grade 1 patients were white and 44% were black. In Grade 2, 53.3% were white and 46.7% were black and in Grade 3 disease, 70.5% were black and 29.5% were white (p = 0.008). Up to the inner third of myometrial invasion had occurred in 60.6% of white patients and 39.4% in black patients. The middle third of the myometrium was invaded in 60.7% of white patients, and 39.3% of black patients. Thirty-seven percent of outer third of myometrial invasion was found in white patients and 63% in black patients (p = 0.038). Seventy-two percent of positive lymph nodes were found in black patients and 28.0% in white patients (p = 0.01). Sixty-one percent of patients with positive peritoneal cytology were black as compared to 38.7% in white patients (p = 0.017). The overall ten-year corrected survival for white and black patients was 72% and 40%, respectively (p = 0.0003). Survivals comparisons, when stratified by race and each prognostic group, showed statistically significant overall survival differences in favor of white patients. CONCLUSION Black patients with endometrial carcinoma have poor survival. Low socio-economic status (SES) would not explain these findings. More research is required to determine the cause of poor survival in black patients with endometrial carcinoma.
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Affiliation(s)
- H Aziz
- Department of Radiation Oncology, State University of New York, Health Science Center at Brooklyn 11203
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Howard J, Hankey BF, Greenberg RS, Austin DF, Correa P, Chen VW, Durako S. A collaborative study of differences in the survival rates of black patients and white patients with cancer. Cancer 1992; 69:2349-60. [PMID: 1562983 DOI: 10.1002/1097-0142(19920501)69:9<2349::aid-cncr2820690925>3.0.co;2-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 1983, the National Cancer Institute began a social-epidemiologic study of possible behavioral and biologic determinants of black/white racial disparities in cancer survival. The design, methodology, underlying hypotheses, and patient accrual of this study are discussed. Survival differences in four organ sites are investigated: cancers of the uterine corpus, breast, bladder, and colon. The first three sites were chosen because of significant observed black/white differentials in survival. Although racial disparities in survival from colon cancer are less prominent, this site was included because it is a leading cause of deaths attributable to cancer, because regional variations have been observed in black/white survival disparities, and because colon data permit cross-gender comparisons. Data collection centers for the study included the Georgia Center for Cancer Statistics, the Louisiana Tumor Registry, and the California Tumor Registry. Probability samples of patients newly diagnosed with these cancers were drawn from the areas served by these registries. Diagnostic years of eligibility were 1985 to 1986 for breast and colon cancer, and 1985 to 1987 for bladder and uterine corpus cancer. Data were collected by personal interview, medical records abstract, physician records, and pathology review. Analyses focus on seven main explanatory hypotheses.
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Affiliation(s)
- J Howard
- Division of Clinical and Prevention Research, National Institute on Alcohol Abuse and Alcoholism/ADAMHA, Public Health Service, Rockville, Maryland
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26
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Kogevinas M, Marmot MG, Fox AJ, Goldblatt PO. Socioeconomic differences in cancer survival. J Epidemiol Community Health 1991; 45:216-9. [PMID: 1757764 PMCID: PMC1060761 DOI: 10.1136/jech.45.3.216] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE The aim was to investigate the relationship between socioeconomic status and cancer survival. DESIGN This was a prospective study, linking census and vital registration records for an approximate 1% representative sample of those enumerated in England and Wales in the 1971 census. SETTING The study population is nationwide. PARTICIPANTS The study sample consists of 250,588 men and 262,484 women. During 1971-81, 17,844 cases of cancer were registered, and of those registered, 13,532 died during 1971-1983. MEASUREMENTS AND MAIN RESULTS Socioeconomic status was assessed in terms of housing tenure. Council tenants, the low socioeconomic group, had poorer survival than owner occupiers, the high socioeconomic group, for the combined group of all neoplasms, and for 11 out of 13 neoplasms examined in males, and 12 out of 15 neoplasms examined in females. Differences were found irrespective of age, cause of death and prognosis of the cancer. Survival analysis by length of follow up indicated that council tenants were more likely to present at a later stage than owner occupiers. CONCLUSIONS Wide survival differentials were observed between socioeconomic groups. Differences in survival for cancers of poor prognosis (eg, oesophagus, pancreas, lung) where treatment has little effect, cannot be attributed to socioeconomic differences in treatment. The survival differences for cancers of good prognosis (eg, corpus uteri, bladder, skin) could, in part, be due to differences in treatment. It is probable that delay in seeking care is one of the major contributing causes.
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Affiliation(s)
- M Kogevinas
- Department of Community Medicine, University College London and Middlesex School of Medicine, United Kingdom
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Schwartz SM, Thomas DB. A case-control study of risk factors for sarcomas of the uterus. The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives. Cancer 1989; 64:2487-92. [PMID: 2684386 DOI: 10.1002/1097-0142(19891215)64:12<2487::aid-cncr2820641214>3.0.co;2-k] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Using data collected as part of the hospital-based World Health Organization (WHO) Collaborative Study of Neoplasia and Steroid Contraceptives, the authors examined potential risk factors for sarcoma of the uterus. Twenty-nine patients with uterine sarcoma who were between 15 and 56 years of age and diagnosed at one of nine centers were matched on age and center to 198 controls selected from hospital admissions to other than obstetric and gynecologic wards. All women were interviewed regarding their medical and reproductive history, methods of birth control, and history of sexual relationships and of sexually transmitted infections. The risk of uterine sarcoma was lower in parous women compared to nulliparous women (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.1, 3.3), and the risk decreased with increasing number of live births. A greater proportion of cases than controls reported giving birth to their first child at the age of 25 or later, even after adjustment for parity (OR = 3.5; 95% CI = 1.2, 10.9). Cases were also more likely than controls to report a history of a spontaneous abortion (OR = 2.5; 95% CI = 0.8, 7.4) or an induced abortion (OR = 1.6; 95% CI = 0.4, 6.3). Late menarche and early menopause were both positively associated with the risk of uterine sarcoma. No association was observed with a history of infertility, use of oral contraceptives, or measures of sexual activity. The findings with respect to childbearing and menstrual history differ from those of a recent cohort study, and indicate the need for larger investigations to assess the role of these and other risk factors in the occurrence of sarcomas of the uterus.
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Affiliation(s)
- S M Schwartz
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington
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Letters to the Editor. Med Chir Trans 1986. [DOI: 10.1177/014107688607901225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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