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Ethnic Differences in Survival Following Diagnosis of Breast Cancer -- Hawaii

For 1960-1979, data from the Hawaii Tumor Registry were used to evaluate ethnic differences in survival following diagnosis of breast cancer (1). The 2,956 cases of invasive breast carcinoma diagnosed in women of five major ethnic groups in Hawaii (Caucasian, Japanese, Hawaiian/part Hawaiian, Chinese, Filipino) were classified as to survival status up to 60 months following diagnosis. Multivariate analysis was used to adjust simultaneously for age, marital status, socioeconomic status (SES), histology, and stage for each ethnic group. A covariate-adjusted relative risk (RR) of death in each ethnic group compared to one group used as a reference was calculated.

Japanese women in Hawaii experienced a longer survival rate than women in other ethnic groups in Hawaii (Table 1). Assigning Japanese a relative risk of 1.0 of dying within 5 years of diagnosis of breast cancer, Chinese were 18%; Caucasians, 34%; Filipinos, 124%; and Hawaiians, 151% more likely than Japanese to die within 5 years of diagnosis. By controlling for stage, the RR decreased considerably, although Filipinos and Hawaiians still had significantly poorer survival than the Japanese and the Caucasians. Further statistical adjustment of the data for differences in age at diagnosis and SES had little effect on survival. The addition of histology and marital status to the regression model did not result in further change in the RR. Reported by L LeMarchand, MD, LN Kolonel, MD, AMY Nomura, MD, Cancer Research Center of Hawaii, University of Hawaii at Manoa; LP Boss, PhD, Cancer Control Applications Br, National Cancer Institute.

Editorial Note

Editorial Note: Previous U.S. studies have suggested that Japanese experience the highest survival following diagnosis for breast cancer, and blacks and American Indians experience the lowest (2). Survival rates for other ethnic groups (Hawaiians; Chinese; white, non-Hispanics; Hispanics; and Filipinos) fall in between. However, studies comparing survival of persons from different geographic areas are difficult to interpret because of possible differences in criteria for staging, facilities for diagnosis, treatment, follow-up, variations in general health status, and other health practices. Because of reasonably standardized medical practices in Hawaii, such problems are minimized, and survival experiences of various ethnic groups can be more validly examined in that population (1).

Stage of disease at diagnosis is clearly the major determinant of survival. The control group of women in a major randomized trial who were not screened for but developed breast cancer experienced not only a lower survival rate than the screened intervention group but also a substantially lower 5-year survival rate for nonwhite women than for white women. This finding is consistent with experience in the general population. However, the study group that received periodic screening with mammography and palpation of the breast experienced no difference in survival rates for white and nonwhite women (3).

The American Cancer Society recommends that monthly breast self-examination begin at age 20 and that physical examination of the breast be done at 3-year intervals between the ages of 20 years and 40 years, and annually thereafter. A baseline mammogram should be taken between 35 years and 40 years, followed by annual or biennial mammograms from 40 years to 49 years, and annual mammograms for age 50 on (4).

References

  1. LeMarchand L, Kolonel LN, Nomura AMY. Relationship of ethnicity and other prognostic factors to breast cancer survival patterns in Hawaii. J Natl Cancer Inst 1984;73:1259-65.

  2. Young JL Jr, Ries LG, Pollack ES. Cancer patient survival among ethnic groups in the United States. J Natl Cancer Inst 1984;73:341-52.

  3. Shapiro S, Venet W, Strax P, Venet L, Roeser R. Prospects for eliminating racial differences in breast cancer survival rates. Am J Public Health 1982;72:1142-5.

  4. National Cancer Institute. The breast cancer digest. Bethesda, Maryland: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, 1984; NIH publication no. 84-1691.



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