Impact of Race on Breast Cancer in Lower Socioeconomic Status Women

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Abstract
Lower socioeconomic status and lack of access to care are often implicated as plausible causes for African American women to present with later stage breast cancer than Caucasian women. Our objective is to determine if racial differences are present in newly diagnosed breast cancer in women of equivalent socioeconomic status. A retrospective review of prospectively gathered data from women with newly diagnosed breast cancer was performed. All women presented to the indigent (uninsured and below the poverty line) breast clinic for evaluation and treatment of their breast pathology. Data pertaining to epidemiologic factors, diagnosis, pathology, and treatment were collected. The data were analyzed by chi-squared and tailed t-tests. Between March 2002 and May 2004, 52 women (African American=36, Caucasian=16) were diagnosed with breast cancer at our clinic. The median age for both groups at presentation was 56.6 years. The staging assessment based on the pathologic size of the tumor was also equivalent between African American and Caucasian women at 2.29 cm and 2.21 cm, respectively. Metastatic lymph node involvement occurred in 14 women (African American=7, Caucasian=7), with 19.4% African American and 43.8% Caucasian being node positive (p=0.068). In fact, there were no statistically significant differences between the races for menarche, menopause, body mass index (BMI), duration of symptoms before presentation, type of diagnostic biopsy or surgery chosen, histology, receptor status, utilization of chemotherapy and radiation, and length of follow-up. The only statistical differences found were in the age of the first live birth (African American=19, Caucasian=22; p=0.028), the use of ultrasound in initial evaluation of a breast mass (less use in African American; p=0.012), and utilization of sentinel lymph node biopsy (Caucasian=75%, African American=42%; p=0.026). Breast cancer in African American women traditionally presents at a more advanced stage and with poor prognostic features. However, when matched for lower socioeconomic status, racial disparities essentially disappear.