作者：Roxanne Nelson
出處：WebMD醫學新聞
November 24, 2008 — 黑人婦女比白人婦女更可能診斷有雌激素受體或黃體素受體(ER/PR)陰性乳癌；除了種族之外，社經地位與其他腫瘤特徵對此類病患的預測也很重要。
相較於白人婦女，黑人婦女診斷有ER/PR陰性乳癌的比率是ER/PR陽性乳癌的2.26倍；當資料控制社會經濟因素，包括教育程度與保險狀況時，黑人婦女有ER/PR陰性乳癌的比率仍舊是白人婦女的1.97倍。
這項研究發表於最近在華盛頓特區舉行的第7屆美國癌症研究國際研討會國際防癌年會。
相較於ER/PR陰性乳癌，ER/PR陽性乳癌病患一般有較佳的預後，離疾病復發有比較長的時間，整體存活也較久。
研究共同作者、美國癌症學會癌症監控研究主任Elizabeth Ward博士在簡報時表示，之前的研究指出黑人婦女比白人婦女更可能診斷有受體陰性乳房腫瘤，不過，對這些腫瘤類型和其他腫瘤特徵與社會經濟因素之間的關係，還需要更多資訊。
Ward博士等人使用全國癌症資料庫，該資料庫蒐集了近1,500家防癌醫院的臨床特徵與人口統計學資料，相當於美國全部癌症病患的70%，用這些資料評估種族、社會經濟因素與乳癌之間的關係。
他們總共研究175,820名年紀在18至99歲之間的婦女，這些人在2004至2005年間診斷有乳癌，使用分布次數評估荷爾蒙受體狀態與人口統計學和臨床變項之間的關係，使用多變項邏輯回歸模式，控制年紀、種族、保險狀態、教育程度、腫瘤分期、組織學與腫瘤大小等，檢視這些關聯。
Ward博士表示，我們發現非裔美籍的乳癌病患有35%是ER/PR陰性，而白人婦女中則只有20%，這與之前文獻所指的一致。
黑人婦女也比較可能在較年輕(<50歲)時診斷有乳癌，且診斷時腫瘤比較晚期、比較大、等級較高；她解釋，這些腫瘤特徵全部與較不佳的預後有關。
Ward博士表示，沒有保險或者沒有Medicaid保險的婦女、以及居住在教育程度較低區域的婦女，診斷為ER/PR陰性乳癌的風險也比較高；控制社會經濟因素後，非裔美國人的荷爾蒙受體陰性腫瘤風險依舊是白人婦女的近2倍。
針對腫瘤特徵如分期、大小、組織學，後續分析其勝算比(相對風險1.85)。
Ward博士重申，這些結果確認了之前的報告，黑人婦女比較可能診斷有ER/PR陰性乳癌，其中有三分之一的過度風險是因為社會經濟因素、診斷時的分期、腫瘤大小與組織學等的差異。她結論表示，值得繼續研究種族、社會經濟狀態、保險狀態與荷爾蒙受體狀態之間的關係。這些差異與不同的乳癌風險因素如生殖因素、肥胖和醫療照護的接受度等有關。
第7屆美國癌症研究國際研討會國際防癌年會：摘要B122。發表於2008年11月18日。
AACR FCPR 2008: ER/PR-Negative Breast Cancer Linked to Race and Socioeconomic Status
By Roxanne Nelson
Medscape Medical News
November 24, 2008 — Black women are more likely than white women to be diagnosed with estrogen- or progesterone-receptor (ER/PR) negative breast cancer. In addition to race, socioeconomic status and other tumor characteristics are important predictors of this disease subtype.
Compared with white women, black women are 2.26 times more likely to be diagnosed with ER/PR-negative than with ER/PR-positive breast cancer. When the data were controlled for socioeconomic factors, including educational levels and insurance status, black women remained 1.97 times more likely to have ER/PR-negative tumors than white women.
The study results were presented at the recent Seventh Annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research, held in Washington, DC.
Breast cancer patients with ER/PR-positive tumors generally have a better prognosis, as indicated by a longer interval to disease recurrence and a longer overall survival, than women with ER/PR-negative tumors.
"Previous research has documented that black women are more likely to be diagnosed with receptor-negative breast tumors, compared with white women," said study coauthor Elizabeth Ward, PhD, director of cancer surveillance research at the American Cancer Society, during a press briefing. "However, there is still a need for more information about the association between these types of tumors and socioeconomic factors, as well as other tumor characteristics."
Dr. Ward and colleagues used the National Cancer Database, which collects information on demographic and clinical characteristics from approximately 1500 Commission on Cancer–approved hospitals, accounting for nearly 70% of all cancer patients treated in the United States, to evaluate the relation between race, socioeconomics, and breast cancer.
They identified a total of 175,820 women between the ages of 18 and 99 years, who were diagnosed with breast cancer during 2004 and 2005. Frequency distributions were used to assess the relation between hormone-receptor status and demographic and clinical variables, and multivariate logistic regression models were used to examine these associations while controlling for age, race, insurance status, educational attainment, stage, histology, and tumor size.
"We found that 35% of breast cancers among African American women were ER/PR negative, compared with 20% among white women," said Dr. Ward. "This is consistent with what has previously been shown in the literature."
Black women were also more likely to be diagnosed with breast cancer at a younger age (<50 years), with late-stage tumors, larger tumors, and higher-grade tumors. "All of these tumor characteristics are associated with poorer prognosis," she explained.
"Women who were uninsured or Medicaid insured and those living in areas with lower educational attainment also had higher odds of being diagnosed with ER/PR-negative breast tumors," said Dr. Ward. "After controlling for socioeconomic factors, African American women were still almost 2 times as likely to have hormone-receptor-negative tumors as white women."
Investigation into tumor characteristics, such as stage, size, and histology, further attenuated the odds ratio (relative risk,1.85).
Dr. Ward reiterated that these results confirm previous reports that black women are more likely to be diagnosed with ER/PR-negative breast cancer, but a third of this excess risk was explained by differences in socioeconomic factors, stage at diagnosis, tumor size, and histology type. "Associations of race, socioeconomic status, and insurance status with hormone-receptor status merit further study," she concluded. "These differences could be related to different exposures to breast cancer risk factors, including reproductive factors, obesity, and access to medical care."
American Association for Cancer Research's Seventh Annual International Conference on Frontiers in Cancer Prevention Research: Abstract B122. Presented November 18, 2008.
[ 本帖最後由 goodcat1111 於 2008-12-2 11:10 編輯 ] |
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