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Am J Public Health. 1986 December; 76(12): 1400–1403.
PMCID: PMC1646981

Social class and black-white differences in breast cancer survival.


In the United States, Blacks have poorer survival rates than Whites for breast cancer. The root of this difference--social or genetic--is unclear. Utilizing the Western Washington Cancer Surveillance System and 1980 Census block group data, we examined social class and race as predictors of breast cancer survival in 1,506 women during their first 11 years following diagnosis (251 Blacks, 1,255 Whites). In a Cox regression model, after adjustment for Black-White differences in age, stage, and histology, Black mortality was 1.35 times that of Whites (95%CI = 1.05-1.72). Following additional adjustment for social class, as measured by a variety of block group characteristics, Black mortality was only 1.10 times that of Whites (95%CI = 0.83-1.46). In both Blacks and Whites, poorer social class was a powerful determinant of shortened survival. These results indicate that the observed breast cancer survival differences between Black and White women today in the US today is substantially due to the poorer social class standing of Blacks.

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Selected References

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  • Young JL, Jr, Ries LG, Pollack ES. Cancer patient survival among ethnic groups in the United States. J Natl Cancer Inst. 1984 Aug;73(2):341–352. [PubMed]
  • Axtell LM, Myers MH. Contrasts in survival of black and white cancer patients, 1960-73. J Natl Cancer Inst. 1978 Jun;60(6):1209–1215. [PubMed]
  • Mausner JS, Shimkin MB, Moss NH, Rosemond GP. Cancer of the breast in Philadelphia hospitals 1951-1964. Cancer. 1969 Feb;23(2):260–274. [PubMed]
  • Linden G. The influence of social class in the survival of cancer patients. Am J Public Health Nations Health. 1969 Feb;59(2):267–274. [PMC free article] [PubMed]
  • Lipworth L, Abelin T, Connelly RR. Socio-economic factors in the prognosis of cancer patients. J Chronic Dis. 1970 Aug;23(2):105–115. [PubMed]
  • Gregorio DI, Cummings KM, Michalek A. Delay, stage of disease, and survival among White and Black women with breast cancer. Am J Public Health. 1983 May;73(5):590–593. [PMC free article] [PubMed]
  • Dennis CR, Gardner B, Lim B. Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer. Cancer. 1975 Mar;35(3):714–720. [PubMed]
  • Dayal HH, Power RN, Chiu C. Race and socio-economic status in survival from breast cancer. J Chronic Dis. 1982;35(8):675–683. [PubMed]
  • Adams M, Kerner JF. Evaluation of promotional strategies to solve the problem of underutilization of a breast examination education center in a New York City black community. Prog Clin Biol Res. 1982;83:151–161. [PubMed]
  • LeMarchand L, Kolonel LN, Nomura AM. Relationship of ethnicity and other prognostic factors to breast cancer survival patterns in Hawaii. J Natl Cancer Inst. 1984 Dec;73(6):1259–1265. [PubMed]
  • Howard J, Lund P, Bell G. Hospital variations in metastatic breast cancer. Med Care. 1980 Apr;18(4):442–455. [PubMed]
  • Morrison AS, Lowe CR, MacMahon B, Warram JH, Jr, Yuasa S. Survival of breast cancer patients related to incidence risk factors. Int J Cancer. 1972 May 15;9(3):470–476. [PubMed]
  • Mohla S, Enterline JP, Sampson CC, Khan T, Leffall L, Jr, White JE. A predominance of poorly differentiated tumors among black breast cancer patients: management and screening implications. Prog Clin Biol Res. 1982;83:249–258. [PubMed]
  • Hulka BS, Chambless LE, Wilkinson WE, Deubner DC, McCarty KS, Sr, McCarty KS., Jr Hormonal and personal effects on estrogen receptors in breast cancer. Am J Epidemiol. 1984 May;119(5):692–704. [PubMed]
  • Berg JW, Ross R, Latourette HB. Economic status and survival of cancer patients. Cancer. 1977 Feb;39(2):467–477. [PubMed]
  • Savage D, Lindenbaum J, Van Ryzin J, Struening E, Garrett TJ. Race, poverty, and survival in multiple myeloma. Cancer. 1984 Dec 15;54(12):3085–3094. [PubMed]
  • Wegner EL, Kolonel LN, Nomura AM, Lee J. Racial and socioeconomic status differences in survival of colorectal cancer patients in Hawaii. Cancer. 1982 May 15;49(10):2208–2216. [PubMed]
  • Page WF, Kuntz AJ. Racial and socioeconomic factors in cancer survival. A comparison of Veterans Administration results with selected studies. Cancer. 1980 Mar 1;45(5):1029–1040. [PubMed]
  • Syme SL, Berkman LF. Social class, susceptibility and sickness. Am J Epidemiol. 1976 Jul;104(1):1–8. [PubMed]
  • Shapiro S, Venet W, Strax P, Venet L, Roeser R. Prospects for eliminating racial differences in breast cancer survival rates. Am J Public Health. 1982 Oct;72(10):1142–1145. [PMC free article] [PubMed]
  • Wilkinson GS, Edgerton F, Wallace HJ, Jr, Reese P, Patterson J, Priore R. Delay, stage of disease and survival from breast cancer. J Chronic Dis. 1979;32(5):365–373. [PubMed]
  • DeVita VT., Jr Cancer Prevention Awareness Program: targeting black Americans. Public Health Rep. 1985 May-Jun;100(3):253–254. [PMC free article] [PubMed]

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