This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (137)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Men's Health  • Prostate Disease  • Breast Cancer  • Colon Cancer  • Head & Neck Cancer  • Prostate Cancer  • Oncology, Other  • Otolaryngology/ Head & Neck Surgery  • Neoplasms of Head & Neck  • Pulmonary Diseases  • Pulmonary Diseases, Other  • Quality of Care  • Evidence-Based Medicine  • Review  • Gastroenterology  • Gastrointestinal Diseases  • Hematology/ Hematologic Malignancies  • Leukemias/ Lymphomas  • Alert me on articles by topic  Social Bookmarking   What's this?

Peter B. Bach, MD; Deborah Schrag, MD,MPH; Otis W. Brawley, MD; Aaron Galaznik; Sofia Yakren; Colin B. Begg, PhD

JAMA. 2002;287:2106-2113.

Context  In recent years a theory that cancer biology is different in blacks and whites has gained prominence in reaction to epidemiologic observations that blacks have poorer survival than whites, even when diagnosed with cancer of similar severity. Yet, few studies have evaluated whether lower-quality treatment and shorter overall life expectancy due to a greater burden of other illnesses may explain the survival discrepancy.

Objective  To estimate the magnitude of overall and cancer-specific survival differences between blacks and whites who receive comparable treatment for similar-stage cancer.

Data Sources  We searched MEDLINE for English-language articles published from 1966 to January 2002 that reported on overall survival for black and white patients treated similarly for cancer.

Study Selection  The abstracts or titles for 891 citations were independently examined by 2 authors. The full text was retrieved if the abstract mentioned both black and white patients, made some comment regarding either similarity of treatment received or presented an analysis based on the treatment received, and commented on survival. Studies were included if they included data for at least 10 black and 10 white patients; specified the cohort ascertainment method and what measures were undertaken to minimize loss to follow-up; summarized survival of both blacks and whites using actuarial measures; presented outcomes within stage, adjusted for stage, or based on cohorts with balanced stage distributions; and specified that blacks and whites in the study received similar treatment. We identified 89 unique cohorts in 54 articles that met our inclusion criteria.

Data Extraction  Overall survival rates and hazard ratios (HRs) for death for blacks relative to whites were calculated. These were subsequently adjusted for rates of death due to causes other than the cancer under study to determine cancer-specific survival and cancer-specific HRs.

Data Synthesis  Results represent 189 877 white and 32 004 black patients with 14 different cancers. Compared with whites, blacks had an overall excess risk of death (HR, 1.16; 95% confidence interval [CI], 1.12-1.20). After correction for deaths due to other causes, the cancer-specific HR was 1.07 (95% CI, 1.02-1.13). Of the 14 cancers, blacks were at a significantly higher risk of cancer-specific death only for cancer of the breast, uterus, or bladder.

Conclusions  Only modest cancer-specific survival differences are evident for blacks and whites treated comparably for similar-stage cancer. Therefore, differences in cancer biology between racial groups are unlikely to be responsible for a substantial portion of the survival discrepancy. Differences in treatment, stage at presentation, and mortality from other diseases should represent the primary targets of research and interventions designed to reduce disparities in cancer outcomes.

Author Affiliations: Health Outcomes Research Group, Department of Epidemiology and Biostatistics (Drs Bach, Schrag, and Begg and Ms Yakren) and Department of Medicine (Drs Bach and Schrag), Memorial Sloan-Kettering Cancer Center, and Weill Medical College of Cornell University (Mr Galaznik), New York, NY; and Winship Cancer Institute, Emory University, Atlanta, Ga (Dr Brawley).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLES

Race/Ethnicity and Cancer Survival: The Elusive Target of Biological Differences
Catarina I. Kiefe
JAMA. 2002;287(16):2138-2139.
EXTRACT | FULL TEXT  

April 24, 2002
JAMA. 2002;287(16):2153-2154.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is Race Really a Negative Prognostic Factor for Cancer?
Brawley
JNCI J Natl Cancer Inst 2009;0:djp185v1-971.
FULL TEXT  

Cancer Statistics, 2009
Jemal et al.
CA Cancer J Clin 2009;0:caac.20006v3-NA.
ABSTRACT | FULL TEXT  

American Society of Clinical Oncology Policy Statement: Disparities in Cancer Care
Goss et al.
JCO 2009;27:2881-2885.
ABSTRACT | FULL TEXT  

Teaching 'race' at medical school: social scientists on the margin.
Anderson
Social Studies of Science 2008;38:785-800.
ABSTRACT  

Elevated Expression of Glutathione S-Transferase {pi} and p53 Confers Poor Prognosis in Head and Neck Cancer Patients Treated with Chemoradiotherapy but not Radiotherapy Alone
Schumaker et al.
Clin. Cancer Res. 2008;14:5877-5883.
ABSTRACT | FULL TEXT  

Residual Treatment Disparities After Oncology Referral for Rectal Cancer
Morris et al.
JNCI J Natl Cancer Inst 2008;100:738-744.
ABSTRACT | FULL TEXT  

The Basis of Racial Differences in the Incidence of Thyroid Cancer
Morris et al.
Ann. Surg. Oncol. 2008;15:1169-1176.
ABSTRACT | FULL TEXT  

Cancer Statistics, 2008
Jemal et al.
CA Cancer J Clin 2008;0:CA.2007.0010v1-CA.2007.0010.
ABSTRACT | FULL TEXT  

Ethnic differences in cancer incidence and mortality: the Birmingham Factory Screening Project
Lane et al.
QJM 2007;100:423-431.
ABSTRACT | FULL TEXT  

Differences in Prognostic Factors and Survival among White Men and Black Men with Prostate Cancer, California, 1995-2004
Robbins et al.
Am J Epidemiol 2007;166:71-78.
ABSTRACT | FULL TEXT  

Adjuvant Treatment of Colorectal Cancer
Wolpin et al.
CA Cancer J Clin 2007;57:168-185.
ABSTRACT | FULL TEXT  

Patient characteristics and hospital quality for colorectal cancer surgery
Zhang et al.
Int J Qual Health Care 2007;19:11-20.
ABSTRACT | FULL TEXT  

Cancer Statistics, 2007
Jemal et al.
CA Cancer J Clin 2007;57:43-66.
ABSTRACT | FULL TEXT  

Telephone Outreach to Increase Colorectal Cancer Screening in an Urban Minority Population
Basch et al.
Am. J. Public Health 2006;96:2246-2253.
ABSTRACT | FULL TEXT  

Colorectal Cancer Model of Health Disparities: Understanding Mortality Differences in Minority Populations
Polite et al.
JCO 2006;24:2179-2187.
ABSTRACT | FULL TEXT  

Does utilization of screening mammography explain racial and ethnic differences in breast cancer?
Smith-Bindman et al.
ANN INTERN MED 2006;144:541-553.
ABSTRACT | FULL TEXT  

The Ongoing Search for the Sources of the Breast Cancer Survival Disparity
Dignam
JCO 2006;24:1326-1328.
FULL TEXT  

Missed Opportunities: Racial Disparities in Adjuvant Breast Cancer Treatment
Bickell et al.
JCO 2006;24:1357-1362.
ABSTRACT | FULL TEXT  

Cancer statistics, 2006.
Jemal et al.
CA Cancer J Clin 2006;56:106-130.
ABSTRACT | FULL TEXT  

Communication and Racial Inequities in Health Care
Kreps
American Behavioral Scientist 2006;49:760-774.
ABSTRACT  

Lung Cancer and Race: Equal Treatment Yields Equal Outcome Among Equal Patients, but There Is No Equal Treatment
Brawley
JCO 2006;24:332-333.
FULL TEXT  

Minority recruitment to the Selenium and Vitamin E Cancer Prevention Trial (SELECT)
Cook et al.
Clin Trials 2005;2:436-442.
ABSTRACT  

Cancer Screening Among Jail Inmates: Frequency, Knowledge, and Willingness
Binswanger et al.
Am. J. Public Health 2005;95:1781-1787.
ABSTRACT | FULL TEXT  

Minority Adult Survivors of Childhood Cancer: A Comparison of Long-Term Outcomes, Health Care Utilization, and Health-Related Behaviors From the Childhood Cancer Survivor Study
Castellino et al.
JCO 2005;23:6499-6507.
ABSTRACT | FULL TEXT  

Variation in the Choice of Breast-Conserving Surgery or Mastectomy: Patient or Physician Decision Making?
Nattinger
JCO 2005;23:5429-5431.
FULL TEXT  

Racial Differences in Surgical Evaluation, Treatment, and Outcome of Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients
Steyerberg et al.
JCO 2005;23:510-517.
ABSTRACT | FULL TEXT  

Cancer Statistics, 2005
Jemal et al.
CA Cancer J Clin 2005;55:10-30.
ABSTRACT | FULL TEXT  

Endometrial Cancer: Socioeconomic Status and Racial/Ethnic Differences in Stage at Diagnosis, Treatment, and Survival
Madison et al.
Am. J. Public Health 2004;94:2104-2111.
ABSTRACT | FULL TEXT  

Update on the Health Disparities Literature
Long et al.
ANN INTERN MED 2004;141:805-812.
FULL TEXT  

Inequality in Health Care: Unjust, Inhumane, and Unattended!
King and Wheeler
ANN INTERN MED 2004;141:815-817.
FULL TEXT  

Racial Discrepancies in the Outcome of Patients With Hepatocellular Carcinoma
Harrison et al.
Arch Surg 2004;139:992-996.
ABSTRACT | FULL TEXT  

Cancer Disparities by Race/Ethnicity and Socioeconomic Status
Ward et al.
CA Cancer J Clin 2004;54:78-93.
ABSTRACT | FULL TEXT  

Racial Disparities in Rectal Cancer Treatment: A Population-Based Analysis
Morris et al.
Arch Surg 2004;139:151-155.
ABSTRACT | FULL TEXT  

Cancer Statistics, 2004
Jemal et al.
CA Cancer J Clin 2004;54:8-29.
ABSTRACT | FULL TEXT  

Trends in Breast Cancer by Race and Ethnicity
Ghafoor et al.
CA Cancer J Clin 2003;53:342-355.
ABSTRACT | FULL TEXT  

Results of Therapy for Acute Lymphoblastic Leukemia in Black and White Children
Pui et al.
JAMA 2003;290:2001-2007.
ABSTRACT | FULL TEXT  

Survival Variability by Race and Ethnicity in Childhood Acute Lymphoblastic Leukemia
Kadan-Lottick et al.
JAMA 2003;290:2008-2014.
ABSTRACT | FULL TEXT  

Trends in Survival Rates After Allogeneic Hematopoietic Stem-Cell Transplantation for Acute and Chronic Leukemia by Ethnicity in the United States and Canada
Serna et al.
JCO 2003;21:3754-3760.
ABSTRACT | FULL TEXT  

Treatment of Locally Advanced Pancreatic Cancer in the Real World: Population-Based Practices and Effectiveness
Krzyzanowska et al.
JCO 2003;21:3409-3414.
ABSTRACT | FULL TEXT  

Cancer Statistics, 2003
Jemal et al.
CA Cancer J Clin 2003;53:5-26.
ABSTRACT | FULL TEXT  

Advanced Presentation of Lung Cancer in Asian Immigrants: A Case-Control Study
Finlay et al.
Chest 2002;122:1938-1943.
ABSTRACT | FULL TEXT  

Some Perspective on Black-White Cancer Statistics
Brawley
CA Cancer J Clin 2002;52:322-325.
FULL TEXT  

Cancer Statistics for African Americans
Ghafoor et al.
CA Cancer J Clin 2002;52:326-341.
ABSTRACT | FULL TEXT  

Cancer Prevention Science and Practice
Lippman and Hong
Cancer Res. 2002;62:5119-5125.
FULL TEXT  

Race/Ethnicity and Cancer Survival: The Elusive Target of Biological Differences
Kiefe
JAMA 2002;287:2138-2139.
FULL TEXT