Minority Health and Health Equity Archive

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Author: search.filters.author.Schwartz, Kendra

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    Disentangling the effects of race on breast cancer treatment
    (2007) Banerjee, Mousumi; George, Julie; Yee, Cecilia; Hryniuk, William; Schwartz, Kendra
    BACKGROUND. African Americans (AA) have higher mortality from breast cancer compared with white Americans (WA). Studies using population-based cancer registries have attributed this to disparities in treatment after normalizing the AA and WA populations for differences in disease stage. However, those studies were hampered by lack of comorbidity data and limited information about systemic treatments. The objective of the current study was to investigate racial disparities in breast cancer treatment by conducting a comprehensive medical records review of women who were diagnosed with breast cancer at the Karmanos Cancer Institute (KCI) in Detroit, Michigan. METHODS. The study cohort consisted of 651 women who were diagnosed with primary breast cancer between 1990 and 1996 at KCI. Multivariable logistic regression analysis controlling for sociodemographic factors, tumor characteristics, comorbidities, and health insurance status was used to assess whether there were differences between WA and AA in the receipt of breast-conserving surgery (BCS), radiation, tamoxifen, and chemotherapy. RESULTS. There was no significant difference between WA and AA in the receipt of BCS versus mastectomy. Patients with local-stage disease who were enrolled in government insurance plans underwent mastectomy more often (vs BCS plus radiation) compared with patients who were enrolled in nongovernment plans. The rates of receipt of tamoxifen and chemotherapy were similar for local-stage WA and local-stage AA. However, WA were more likely to receive tamoxifen and/or chemotherapy for regional-stage disease. Married women with regional disease were more likely to receive chemotherapy than nonmarried women. CONCLUSIONS. The results from this study may be used to target educational interventions to improve the use of adjuvant therapies among AA women who have regional-stage disease. Cancer 2007 © 2007 American Cancer Society.
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    The Influence of Race, Ethnicity, and Individual Socioeconomic Factors on Breast Cancer Stage at Diagnosis
    (2006) Lantz, Paula M.; Mujahid, Mahasin; Schwartz, Kendra; Janz, Nancy K.; Fagerlin, Angela; Salem, Barbara; Liu, Lihua; Deapen, Dennis; Katz, Steven J.
    Objectives. Previous research has generally found that racial/ethnic differences in breast cancer stage at diagnosis attenuate when measures of socioeconomic status are included in the analysis, although most previous research measured socioeconomic status at the contextual level. This study investigated the relation between race/ethnicity, individual socioeconomic status, and breast cancer stage at diagnosis. Methods.Women with stage 0 to III breast cancer were identified from populationbased data from the Surveillance, Epidemiology, and End Results tumor registries in the Detroit and Los Angeles metropolitan areas. These data were combined with data from a mailed survey in a sample of White, Black, and Hispanic women (n=1700). Logistic regression identified factors associated with early-stage diagnosis. Results. Black and Hispanic women were less likely to be diagnosed with earlystage breast cancer than were White women (P<.001). After control for study site, age, and individual socioeconomic factors, the odds of early detection were still significantly less for Hispanic women (odds ratio [OR]=0.45) and Black women (OR=0.72) than for White women. After control for the method of disease detection, the White/Black disparity attenuated to insignificance; the decreased likelihood of early detection among Hispanic women remained significant (OR=0.59). Conclusion. The way in which racial/ethnic minority status and socioeconomic characteristics produce disparities in women’s experiences with breast cancer deserves further research and policy attention.