New Study Finds Racial Differences in Survival Among Men With Breast Cancer
A study by Sineshaw et al has found that black men with early-stage breast cancer who were younger than age 65 had a 76% higher risk of death than whites. However, the disparity was significantly reduced after adjusting for differences in insurance and income, suggesting the importance of improving access to care in reducing racial disparities in breast cancer mortality among men. The study also found that the excess risk of death in black men vs white men aged 65 and older was not significant. The study is published in the Journal of Clinical Oncology.
Study Methodology
The researchers identified 725 non-Hispanic black and 5,247 non-Hispanic white men diagnosed with early-stage breast cancer between 2004 and 2011 using the National Cancer Data Base, a national hospital-based cancer registry database that captures approximately 70% of newly diagnosed cancer cases in the United States. They then used multivariable logistic regression and calculated standardized risk ratios to predict receipt of treatment and a proportional hazards model to estimate overall hazard ratios (HRs) in black vs white men aged 18 to 64 and in men aged 65 and older, separately.
Study Findings
The researchers found that receipt of treatment between blacks and whites in the two age groups was similar. Black and white older men had lower receipt of chemotherapy (39.2% and 42.0%, respectively) compared with younger patients (76.7% and 79.3%, respectively).
Younger black men had a 76% higher risk of death than younger white men after adjustment for clinical factors only (HR = 1.76; 95% confidence interval [CI] = 1.11–2.78), but this difference significantly diminished after subsequent adjustment for insurance and income (HR = 1.37; 95% CI = 0.83–2.24). In those patients aged ≥ 65 years, the excess risk of death in blacks vs whites was not significant and not affected by adjustment for covariates, such as insurance and income, which may be due to the relatively uniform health-care coverage provided through Medicare.
Additional findings include a higher percentage of black men in the younger age group compared with white men (63% vs 49.8%; P < .001). Compared with white men, black men had a higher proportion of stage II to stage III breast cancer (stage II, 45.4% vs 41.8%; stage III, 20.6% vs 14.3%; P < .001) and estrogen receptor–negative breast cancer (13.8% vs 7.6%; P < .001).
In a subanalysis of the data, younger men had a higher percentage of estrogen receptor–negative breast cancer compared with older men (whites, 10.2% vs 5.0%; blacks, 17.3% vs 7.6%). Blacks were also more likely to be uninsured or Medicaid-insured (14.9% vs 4.3%; P < .001), to receive care in teaching or research centers (28.3% vs 18.9%; P < .001), and to reside in low-income areas (27.7% vs 8.5%; P < .001.
“The excess risk of death in younger black men was significantly reduced when accounting for differences in insurance and income, underscoring the potential importance of poverty in health disparities,” concluded the researchers. “In addition to studying the potential impact of the Affordable Care Act in eliminating health disparities as this law is broadly implemented, future research should focus on how we can better address barriers in access to optimal care and equal outcomes for all men with breast cancer.”
Male Breast Cancer Is Rare
According to the study, male breast cancer is a rare disease, accounting for less than 1% of all cancer in men and approximately 2% of all breast cancers in the United States. However, black men have a higher incidence of breast cancer and are more likely to be diagnosed with breast cancer at a younger age than their white counterparts.
Helmneh M. Sineshaw, MD, PhD, of America Cancer Society, is the corresponding author for the Journal of Clinical Oncology article.
For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
