African-American ethnicity, socioeconomic status, and breast cancer survival: a meta-analysis of 14 studies involving over 10,000 African-American and 40,000 White American patients with carcinoma of the breast

Cancer. 2002 Jun 1;94(11):2844-54. doi: 10.1002/cncr.10575.


Background: African-American women are at increased risk for breast cancer mortality compared with white American women, and the extent to which socioeconomic factors account for this outcome disparity is unclear.

Methods: A MEDLINE search was conducted to identify published studies that used a Cox proportional hazards regression model to evaluate the outcome of African-American women and white American women with breast carcinoma after adjusting for socioeconomic status. A meta-analysis was performed using specialized statistical software; the random-effects method of statistical evaluation was used because of the a priori impression that the studies reviewed would be at least moderately heterogeneous in study design and patient populations.

Results: The initial literature search yielded 3962 studies. Fourteen studies met all criteria for inclusion in the meta-analysis, resulting in a sample size of 10,001 African-American patients and 42,473 white American patients with breast carcinoma. There was substantial variation in the method used for defining socioeconomic status. Summary statistics revealed a significant odds ratio of 1.22 (95% confidence interval, 1.13-1.30) for the adverse effect of African-American ethnicity on breast cancer mortality. Subset meta-analyses yielded similar results, supporting the robustness of this finding.

Conclusions: This meta-analysis revealed that African-American ethnicity is an independent predictor of a worse breast cancer outcome. The pooled analysis has added strength because of the aggregate sample size and indicates that the true biologic and/or therapeutic determinants of disparities in breast cancer outcome for different ethnic groups and for different socioeconomic strata are incompletely understood.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Continental Ancestry Group*
  • Aged
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / mortality*
  • European Continental Ancestry Group*
  • Female
  • Humans
  • Middle Aged
  • Odds Ratio
  • Proportional Hazards Models
  • Socioeconomic Factors*
  • Survival Rate
  • United States / epidemiology