Cynthia D. O'MAlley

We examined whether Medicaid beneficiaries are more likely to be diagnosed with late-stage cervical cancer than women not enrolled in Medicaid. Using the California Cancer Registry-Medicaid linked file, we identified 4682 women diagnosed during 1996-1999 with invasive cervical cancer. Multivariate logistic regression was used to evaluate the association between late-stage diagnosis and prediagnosis Medicaid status. Late-stage disease was diagnosed in 51% of Medicaid and 42% of non-Medicaid women. Relative to women without Medicaid coverage, adjusted odds ratios for late-stage diagnosis were 2.8 times higher among women enrolled in Medicaid at the time of their diagnosis and 1.3 times higher among those intermittently enrolled before being diagnosed. Vietnamese women were less likely than White women to have advanced disease; the adjusted odds for women in other racial/ethnic groups did not differ from those among Whites. Women of low socioeconomic status and older women were at increased risk. Women intermittently enrolled in Medicaid or not enrolled until their diagnosis were at greatest risk of a late-stage diagnosis, suggesting that more outreach to at-risk women is needed to ensure access to screening services.

Background: Few studies have examined the effect of breast implants after mastectomy on long-term survival in breast cancer patients, despite growing public health concern over potential long-term adverse health effects. Methods: We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance Study conducted in San Francisco–Oakland, in Seattle–Puget Sound, and in Iowa. This population-based, retrospective cohort included women younger than 65 years when diagnosed with early or unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival time until death due to breast cancer or other causes for women with and without breast implants, adjusted for relevant patient and tumor characteristics. Results: Twenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants comprising the most common type. Patients with implants were younger and more likely to have in situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54; 95% confidence interval, 0.43–0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95% confidence interval, 0.41–0.85) were lower in patients with implants than in those patients without implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade, histology, and radiation therapy. Implant type did not appear to influence long-term survival. Conclusions: In a large, population-representative sample, breast implants following mastectomy do not appear to confer any survival disadvantage following early-stage breast cancer in women younger than 65 years old.

BACKGROUND: Although overall survival for invasive breast carcinoma remains high, black women experience poorer survival than whites. Less is known about the survival of Hispanics and Asians, who may share clinical and socioeconomic risk factors similar to blacks. To better understand racial/ethnic survival patterns, we investigated the effect of socioeconomic status (SES) and disease stage on racial/ethnic differences in breast carcinoma survival in a large population‐based cohort.METHODS: Using data from the Surveillance, Epidemiology, and End Results program (SEER), we identified 10,414 white, 940 black, 1100 Hispanic, and 1180 Asian females diagnosed with breast carcinoma in the Greater San Francisco Bay Area between 1988 and 1992. We used the Kaplan–Meier method to generate survival rates and Cox proportional hazards regression to estimate the risk of death by race/ethnicity, after adjustment for clinical, demographic, and census‐derived SES variables.RESULTS: The 10‐year unadjusted survival rates were 81% for whites, 69% for blacks, 75% for Hispanics, and 79% for Asians. Adjusting for stage decreased the relative risk of mortality for blacks from 1.81 to 1.29; the stage‐adjusted relative risk for Hispanics (1.11) and Asians (1.02) did not differ significantly from whites. Additional adjustment for age, tumor characteristics, and treatment factors did little to alter the relative risk in blacks; adding blue‐collar status to the model further decreased the relative risks for blacks to 1.22. Residing in a blue‐collar neighborhood was independently associated with a 1.16 increase in risk of death.CONCLUSIONS: After adjustment for multiple factors, blacks continue to have slight but significantly poorer survival after breast carcinoma compared with whites, whereas the survival of Hispanics and Asians did not differ from whites. Cancer 2003;97:1303–11. © 2003 American Cancer Society.DOI 10.1002/cncr.11160

BACKGROUND: A rare occurrence, about 1500 men in the United States develop breast carcinoma each year. Little is known about survival patterns at the population level, particularly about racial/ethnic variation.METHODS: Using data from the Surveillance, Epidemiology, and End Results Program, we examined survival rates in 1979 men diagnosed with primary invasive breast carcinoma between 1973 and 1997. Race was defined as non‐Hispanic white, non‐Hispanic black, and other race/ethnicity (predominantly Asian/Pacific Islander and Hispanic). The two outcomes were all‐cause and breast carcinoma‐ specific mortality. Survival curves were drawn using Kaplan–Meier estimates and Cox regression was used to estimate the risk of death with hazard ratios and 95% confidence intervals. For both outcomes, the racial/ethnic survival curves differed significantly when the log rank test was used. Therefore, separate models were run for each racial/ethnic group. Covariates included age, stage, histology, surgery, radiation therapy, and year of diagnosis. Estrogen and progesterone receptor status were available for 616 men.RESULTS: Survival rates differed significantly by race/ethnicity. Overall, 5‐year survival rates were 66% for whites, 57% for blacks, and 75% for men of other race/ethnicity. Blacks presented with more advanced disease. By stage, whites and blacks had worse survival rates compared with men of other race/ethnicity. The effects of prognostic factors such as age, surgery type, and radiation were similar, but not always significant, for all groups. Diagnosis year and estrogen receptor status did not affect survival.CONCLUSIONS: Survival following male breast carcinoma differed by race/ethnicity, whereas the prognostic factors associated with survival were similar. Cancer 2002;94:2836–43. Published 2002 American Cancer Society.DOI 10.1002/cncr.10521

Information is limited for Asian subgroups regarding survival after diagnosis of the common cancers amenable to routine screening. The authors examined survival after carcinomas of the prostate, colon/rectum, breast, and cervix separately for Chinese, Japanese, Filipinos, and non-Hispanic whites in the United States. Using data from the Surveillance, Epidemiology, and End Results program, the authors compared the distributions of stage at diagnosis and computed 5-year cause specific survival probabilities, overall and by stage of disease, for cancer patients whose diagnosis was in 1988-1994 and who were observed through 1997. Among males, Filipinos were more likely to be diagnosed with advanced stage colorectal and prostate carcinomas than other Asians and non-Hispanic whites; they also experienced worse survival after these cancers. This survival deficit occurred across all stages of colorectal carcinoma and remained apparent within distant stage prostate carcinoma. Among females, Chinese were less likely to receive diagnoses of early stage colorectal carcinoma than Japanese and Filipinas. In addition, their survival was consistently lower across more advanced stages of disease. Chinese also experienced somewhat worse survival after diagnosis of early stage cervical carcinoma. Japanese were more likely to be diagnosed with early stage carcinomas but also tended to experience better survival after prostate, colorectal, and breast carcinomas regardless of stage. Chinese, Japanese, and Filipinos experienced unequal survival after these screenable carcinomas, indicating that certain groups may benefit from more aggressive screening efforts. The heterogeneity of cancer outcomes observed within the community classified as Asian reinforces the need for cancer statistics to be reported for disaggregated subgroups.