Racial differences in breast cancer survival: the interaction of socioeconomic status and tumor biology

Am J Obstet Gynecol. 1997 Jun;176(6):S233-9. doi: 10.1016/s0002-9378(97)70381-8.


Objective: Our purpose was to evaluate the effect of sociodemographic and clinical variables on survival rates of African-American and white women with breast cancer.

Study design: Between 1988 and 1992 the Metropolitan Detroit Cancer Surveillance System Identified 10,502 women (82% white and 18% African-American) in whom invasive breast cancer was diagnosed. Cox proportional hazards regression was used to estimate the relative risk of death for African-Americans compared with whites after controlling for variables believed to influence survival.

Results: African-American women were more likely than white women to have tumors that were of a more advanced stage, a higher grade, and hormone receptor-negative. After controlling for age, tumor size, stage, histologic grade, census-derived socioeconomic status, and the presence of a residency training program at the treatment hospital, the relative risk of dying for African-Americans compared with whites was 1.68 (95% confidence interval, 1.27-2.23) for women less than 50 years of age, and 1.33 (95% confidence interval, 1.13-1.56) for women older than 50 years of age.

Conclusions: Known factors that predict survival differences between African-Americans and whites are more prevalent among women less than 50 years of age, emphasizing the need to focus more attention on public health efforts directed toward younger women.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / genetics*
  • Aged
  • Breast / chemistry
  • Breast / pathology
  • Breast / surgery
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / genetics*
  • Breast Neoplasms / mortality*
  • European Continental Ancestry Group / genetics*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Staging
  • Ohio / epidemiology
  • Prevalence
  • Proportional Hazards Models
  • Public Health
  • Receptors, Estrogen / analysis
  • Receptors, Progesterone / analysis
  • Risk Factors
  • Social Class*
  • Survival Rate
  • Urban Health


  • Receptors, Estrogen
  • Receptors, Progesterone