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      The Influence of Socioeconomic Status on Racial/Ethnic Disparities among the ER/PR/HER2 Breast Cancer Subtypes

      research-article
      * ,
      Journal of Cancer Epidemiology
      Hindawi Publishing Corporation

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          Abstract

          Background. The eight ER/PR/HER2 breast cancer subtypes vary widely in demographic and clinicopathologic characteristics and survival. This study assesses the contribution of SES to the risk of mortality for blacks, Hispanics, Asian/Pacific Islanders, and American Indians when compared with white women for each ER/PR/HER2 subtype. Methods. We identified 143,184 cases of first primary female invasive breast cancer from the California Cancer Registry between 2000 and 2012. The risk of mortality was computed for each race/ethnicity within each ER/PR/HER2 subtype. Models were adjusted for tumor grade, year of diagnosis, and age. SES was added to a second set of models. Analyses were conducted separately for each stage. Results. Race/ethnicity did not contribute to the risk of mortality for any subtype in stage 1 when adjusted for SES. In stages 2, 3, and 4, race/ethnicity was associated with risk of mortality and adjustment for SES changed the risk only in some subtypes. SES reduced the risk of mortality by over 45% for American Indians with stage 2 ER+/PR+/HER2− cancer, but it decreased the risk of mortality for blacks with stage 2 triple negative cancer by less than 4%. Conclusions. Racial/ethnic disparities do not exist in all ER/PR/HER2 subtypes and, in general, SES modestly alters these disparities.

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          Most cited references82

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          Measurement of socioeconomic status in health disparities research.

          Socioeconomic status (SES) is frequently implicated as a contributor to the disparate health observed among racial/ ethnic minorities, women and elderly populations. Findings from studies that examine the role of SES and health disparities, however, have provided inconsistent results. This is due in part to the: 1) lack of precision and reliability of measures; 2) difficulty with the collection of individual SES data; 3) the dynamic nature of SES over a lifetime; 4) the classification of women, children, retired and unemployed persons; 5) lack of or poor correlation between individual SES measures; and 6) and inaccurate or misleading interpretation of study results. Choosing the best variable or approach for measuring SES is dependent in part on its relevance to the population and outcomes under study. Many of the commonly used compositional and contextual SES measures are limited in terms of their usefulness for examining the effect of SES on outcomes in analyses of data that include population subgroups known to experience health disparities. This article describes SES measures, strengths and limitations of specific approaches and methodological issues related to the analysis and interpretation of studies that examine SES and health disparities.
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            Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States.

            Women with early-stage breast cancers are expected to have excellent survival rates. It is important to identify factors that predict diagnosis of early-stage breast cancers.
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              Socioeconomic status and breast cancer incidence in California for different race/ethnic groups.

              The majority of research on breast cancer risk and socioeconomic status (SES) has been conducted for blacks and whites. This study evaluates the relationship between SES and breast cancer incidence in California for four race/ethnic groups. Principal component analysis was used to create an SES index using 1990 Census data. Untracted cases were randomly allocated to census block groups within their county of residence. A total of 97,227 female breast cancer cases diagnosed in California between 1988 and 1992 were evaluated. Incidence rates and rate ratios (RRs) were estimated and a chi2 test for trend across SES levels was performed. SES was positively related to breast cancer incidence, and this effect was stronger for Hispanics and Asian/others than for whites and blacks. Adjusting by SES did not eliminate the differences in breast cancer rates among race/ethnic groups. RR differences between the race/ethnic groups were greatest in the lowest SES category and attenuated with increasing SES. An increasing trend over SES was statistically significant for all race/ethnic groups. Including randomly allocated cases affected RR estimates for white women only. Our results are consistent with similar findings for the Los Angeles area but differ from previous results for the San Francisco Bay area.
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                Author and article information

                Journal
                J Cancer Epidemiol
                J Cancer Epidemiol
                JCE
                Journal of Cancer Epidemiology
                Hindawi Publishing Corporation
                1687-8558
                1687-8566
                2015
                3 August 2015
                : 2015
                : 813456
                Affiliations
                Sutter Institute for Medical Research, Sacramento, CA, USA
                Author notes

                Academic Editor: P. Vineis

                Article
                10.1155/2015/813456
                4539118
                26339244
                7b36a4ab-5ba2-4924-bbf6-02af9f14a8b1
                Copyright © 2015 C. A. Parise and V. Caggiano.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 May 2015
                : 30 June 2015
                : 8 July 2015
                Categories
                Research Article

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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