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
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.
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.
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.
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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