Assessing Outcomes and Socioeconomic and Racial Disparities Using Data from the National Cancer Institute’s SEER Program

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Factors frequently contributing to the diagnosis of early-stage (local-stage) breast cancer, as well as excess deaths among African American women include socioeconomic and treatment variables.

Hardy and colleagues assessed socioeconomic and treatment predictive factors for early-stage breast cancer among African American and Caucasian women cohorts. Predictors and overall risks associated with all-cause and breast cancer–specific mortality were secondary goals to be assessed.

In this retrospective cohort population-based study, the researchers investigated data from the Surveillance, Epidemiology, and End Results (SEER) Program, focused on 547,703 women aged ≥20 years who were diagnosed with breast cancer primary tumors between 2007 and 2016.

They found that when compared with Caucasian women, African American women were more likely to be diagnosed at advanced stage, had larger tumor size at diagnosis, and were treated less frequently with cancer-directed surgery, yet received more chemotherapy. In addition, when compared with Caucasian women, a higher percentage of African American women with breast cancer received less radiation therapy.

Notably, women were more likely to be diagnosed at an early stage and to have smaller tumors (P <.05) if they were insured (>50%).

At the county level, there were statistically significant differences in early-stage diagnosis, tumor size, and treatment by socioeconomic status factors (education level, poverty level, and household income) that were detected. However, the investigators suggested that for patients diagnosed at an early stage, education, poverty, and household income did not have an impact on racial disparities or socioeconomic health disparities in breast cancer.

All-cause mortality and breast cancer–specific mortality risk was higher among African American women compared with Caucasian women after adjusting for demographic, socioeconomic, and treatment factors.

The investigators determined that in this population-based analysis that utilized the most recent data from SEER, when comparing breast cancer patients who were Caucasian versus African American women, there was a disproportionate elevation of breast cancer–specific and all-cause mortality among the latter group.


Hardy D, Du DY. Socioeconomic and racial disparities in cancer stage at diagnosis, tumor size, and clinical outcomes in a large cohort of women with breast cancer, 2007-2016. J Racial Ethn Health Disparities. 2021;8:990-1001.

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