Cancer Causes & Control

, Volume 24, Issue 9, pp 1705–1715 | Cite as

Disparities in survival after female breast cancer diagnosis: a population-based study

  • Stacey L. Tannenbaum
  • Tulay Koru-Sengul
  • Feng Miao
  • Margaret M. Byrne
Original paper



Despite advances in treatment and increased screening, female breast cancer survival is affected by race, ethnicity, and socioeconomic status (SES). The purpose of this study was to substantiate disparities in breast cancer mortality in a large and unique dataset containing 7 distinct racial groups, 31 comorbidities, demographic and clinical/pathological patient characteristics, and neighborhood poverty information.


Florida Cancer Data System registry (1996–2007) linked with the Agency for Health Care Administration and U.S. Census tract (n = 127,754) explored median survival and 1-, 3-, and 5-year survival rates by the Kaplan–Meier method. Log-rank tests compared survival curves by race/ethnicity/SES. Cox proportional hazards regression models were used to obtain unadjusted and adjusted hazard ratios (HR) and 95 % confidence intervals.


Native Americans had the lowest median survival (7.4 years) and Asians had the highest (12.6 years). For the univariate analysis, worse survival was seen for blacks (HR = 1.44; p < 0.001) and better survival for Asians (HR = 0.71; p < 0.001), Asian Indians or Pakistanis (HR = 0.65; p = 0.013), and Hispanics (HR = 0.92; p < 0.001). Multivariate analysis demonstrated sustained survival detriment for blacks (HR = 1.28; p < 0.001) and improved survival for Hispanics (HR = 0.90; p = 0.001). For SES, there was an incremental improvement in survival for each higher SES category in all analyses (p < 0.001).


Utilizing a large enriched state cancer registry controlling for multiple demographic, clinical, and comorbidities, we fully explored survival disparities in female breast cancer and found certain aspects of race, ethnicity, and SES to remain significantly associated with breast cancer survival. More research is needed to uncover the source of these ongoing disparities.


Breast cancer Survival analysis Health care disparities Ethnicity Socioeconomic status Patient outcomes assessment 



This work was supported by the James & Esther King Florida Biomedical Research Program (Grant number 10 KG-06).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    CDC Centers for Disease Control and Prevention (2012) Cancer among women, 2012. Accessed November 2012
  2. 2.
    CDC Centers for Disease Control and Prevention (2012) Breast Cancer Statistics, 2012. Accessed November 2012
  3. 3.
    Siegel R, DeSantis C, Virgo K et al (2012) Cancer treatment and survivorship statistics. CA Cancer J Clin 62(4):220–241PubMedCrossRefGoogle Scholar
  4. 4.
    National Cancer Institute (2012) SEER Stat Fact Sheets: Breast, 2012. Accessed November 2012
  5. 5.
    Maskarinec G, Sen C, Koga K, Conroy SM (2011) Ethnic differences in breast cancer survival: status and determinants. Women’s Health 7(6):677–687PubMedGoogle Scholar
  6. 6.
    Florida Cancer Data System (2012) Florida’s statewide population-based cancer registry, 2012. Accessed November 2012
  7. 7.
    Agency for Healthcare Administration (2012) Accessed November 2012
  8. 8.
    Chlebowski RT, Chen Z, Anderson GL et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97(6):439–448PubMedCrossRefGoogle Scholar
  9. 9.
    Grann V, Troxel AB, Zojwalla N, Hershman D, Glied SA, Jacobson JS (2006) Regional and racial disparities in breast cancer-specific mortality. Soc Sci Med 62(2):337–347PubMedCrossRefGoogle Scholar
  10. 10.
    Joslyn SA, West MM (2000) Racial differences in breast carcinoma survival. Cancer 88(1):114–123PubMedCrossRefGoogle Scholar
  11. 11.
    O’Malley CD, Le GM, Glaser SL, Shema SJ, West DW (2003) Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study. Cancer 97(5):1303–1311PubMedCrossRefGoogle Scholar
  12. 12.
    Clegg LX, Reichman ME, Miller BA et al (2009) Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: national longitudinal mortality study. Cancer Causes Control 20(4):417–435PubMedCrossRefGoogle Scholar
  13. 13.
    Miller BA, Chu KC, Hankey BF, Ries LA (2008) Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S. Cancer Causes Control 19(3):227–256PubMedCrossRefGoogle Scholar
  14. 14.
    Braun KL, Fong M, Gotay C, Pagano IS, Chong C (2005) Ethnicity and breast cancer in Hawaii: increased survival but continued disparity. Ethn Dis 15(3):453–460PubMedGoogle Scholar
  15. 15.
    Leung GM, Thach TQ, Chan E et al (2005) Short-term, medium-term, long-term, and lifetime risks of developing and dying of breast carcinoma in a Westernized Chinese population: evidence from Hong Kong between 1976 and 2000. Cancer 103(3):501–508PubMedCrossRefGoogle Scholar
  16. 16.
    Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163(1):49–56PubMedCrossRefGoogle Scholar
  17. 17.
    Gomez SL, Clarke CA, Shema SJ, Chang ET, Keegan TH, Glaser SL (2010) Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. Am J Public Health 100(5):861–869PubMedCrossRefGoogle Scholar
  18. 18.
    Redaniel MT, Laudico A, Mirasol-Lumague MR et al (2010) Breast cancer survival in different country settings: comparisons between a Filipino resident population, Filipino-Americans and Caucasians. Breast 19(2):109–114PubMedCrossRefGoogle Scholar
  19. 19.
    Moran MS, Gonsalves L, Goss DM, Ma S (2011) Breast cancers in U.S. residing Indian-Pakistani versus non-Hispanic White women: comparative analysis of clinical-pathologic features, treatment, and survival. Breast Cancer Res Treat 128(2):543–551PubMedCrossRefGoogle Scholar
  20. 20.
    Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK (2002) Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. Arch Intern Med 162(17):1985–1993PubMedCrossRefGoogle Scholar
  21. 21.
    Dasgupta P, Baade PD, Aitken JF, Turrell G (2012) Multilevel determinants of breast cancer survival: association with geographic remoteness and area-level socioeconomic disadvantage. Breast Cancer Res Treat 132(2):701–710PubMedCrossRefGoogle Scholar
  22. 22.
    Du XL, Fang S, Meyer TE (2008) Impact of treatment and socioeconomic status on racial disparities in survival among older women with breast cancer. Am J Clin Oncol 31(2):125–132PubMedCrossRefGoogle Scholar
  23. 23.
    Puliti D, Miccinesi G, Manneschi G et al (2012) Does an organised screening programme reduce the inequalities in breast cancer survival? Ann Oncol 23(2):319–323PubMedCrossRefGoogle Scholar
  24. 24.
    Cross CK, Harris J, Recht A (2002) Race, socioeconomic status, and breast carcinoma in the U.S: what have we learned from clinical studies. Cancer 95(9):1988–1999PubMedCrossRefGoogle Scholar
  25. 25.
    Newman LA, Mason J, Cote D et al (2002) 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 94(11):2844–2854PubMedCrossRefGoogle Scholar
  26. 26.
    Gerend MA, Pai M (2008) Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 17(11):2913–2923PubMedCrossRefGoogle Scholar
  27. 27.
    Vona-Davis L, Rose DP (2009) The influence of socioeconomic disparities on breast cancer tumor biology and prognosis: a review. J Womens Health 18(6):883–893CrossRefGoogle Scholar
  28. 28.
    Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82(5):703–710PubMedCrossRefGoogle Scholar
  29. 29.
    Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163:49–56PubMedCrossRefGoogle Scholar
  30. 30.
    Deshpande AD, Jeffe DB, Gnerlich J, Iqbal AZ, Thummalakunta A, Margenthaler JA (2009) Racial disparities in breast cancer survival: an analysis by age and stage. J Surg Res 153:105–113PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Stacey L. Tannenbaum
    • 1
  • Tulay Koru-Sengul
    • 2
  • Feng Miao
    • 1
  • Margaret M. Byrne
    • 2
    • 3
  1. 1.Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Public Health Sciences, Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of Surgery, Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiUSA

Personalised recommendations