Affiliation of authors: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.
Correspondence to: Robert Millikan, D.V.M., Ph.D., CB #7400, Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599-7400 (e-mail: bob_millikan{at}unc.edu).
Yood et al. (1) reported that differences in survival between African-American and white breast cancer patients were negligible after adjustment for age, income, marital status, and stage at diagnosis. The authors studied enrollees in a managed care program where African-American and white women had equal access to health care and similar surgical treatment for breast cancer (2).
We determined whether racial differences exist in the surgical treatment for breast cancer within the general population and whether this relationship is altered by adjustment for sociodemographic variables. We used data collected from The Carolina Breast Cancer Study, a population-based casecontrol study in North Carolina (3). The study was approved by the Institutional Review Board at the University of North Carolina School of Medicine. Multiple logistic regression was used to estimate odds ratios for the type of surgery received: mastectomy (including simple mastectomy, modified radical mastectomy, and total mastectomy) versus breast-conserving surgery (lumpectomy, segmental mastectomy, partial mastectomy, and quandrantectomy).
The results of our analysis are presented in Table 1. Taken singly without adjustment for other predictors, the strongest predictors of receiving a mastectomy were later stage at diagnosis (based upon the American Joint Committee on Cancer (AJCC) TNM staging system), lower educational level, lower income, residence in a rural area or small town, and African-American race. After mutual adjustment for all predictors, the strongest predictors were later stage at diagnosis, lower educational level, and residence in a rural area or small town. African-American women were more likely to undergo mastectomy than white women [odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.12.0], but the association disappeared after mutual adjustment for all predictors (OR = 1.1; 95% CI = 0.81.7).
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NOTES
Editor's note: Yood et al. declined to respond to the correspondence of Dunmore et al.
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Yood MU, Johnson CC, Blunt A, Abrams J, Wolman E, McCarthy BD, et al. Race and differences in breast cancer survival in a managed care population. J Natl Cancer Inst 1999;91:148791.
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6 Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology 1997;8:6218.[Medline]
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