Black/White Cancer Survival Study
In the early 1980s, a group of investigators proposed to examine the possible social, behavioral, and biological determinants of disparities in cancer survival between black and white cancer patients. The Black/White Cancer Survival Study focused on four common cancers–breast, colon, bladder, and endometrial–which were among those with the greatest racial disparities in survival reported by SEER and the earlier End Results Group. SEER cancer registries in Atlanta, San Francisco, and Louisiana participated in the study, gathering additional information on patients diagnosed from 1985-1987. The original hypotheses guiding the study were: Do lower levels of cancer screening and preventive behaviors among blacks lead to later stages of cancer at diagnosis? Are histological characteristics of tumors in blacks different from those in whites? Do black patients receive less aggressive therapy or have lower treatment compliance compared with whites? How do variations in social support and coping strategies among blacks affect cancer outcomes?
During the following two decades, more than 50 collaborators published more than 20 analyses that examined these questions. Among the results, researchers found that, although stage at diagnosis and access to health care played a part in lower survival rates for blacks, they could not account for all of the disparities found. Even after survival was adjusted for sociodemographic and lifestyle factors and for treatment patterns, differences remained. For breast and endometrial cancers, black women usually were found to have tumors that grew faster, were less responsive to therapy, and carried more poor prognostic features at baseline than did their white counterparts. For colon cancer, more aggressive tumor characteristics did not explain racial differentials in survival, which suggested that other environmental exposure factors and the need for improved biomarker measures of tumor biology and host susceptibility. Blacks were less likely than whites to develop bladder cancer. Once diagnosed, however, blacks experienced poorer survival, primarily due to a greater extent of disease at diagnosis and higher tumor grade. Socioeconomic factors were associated with racial differences in bladder cancer, suggesting that risk and/or prognosis may be mediated by occupation and lifestyle factors, a topic for further study. Followup and analysis of long-term survival is possible for this SEER study cohort.
Howard J, Hankey BF, Greenberg RS, Austin DF, Correa P, Chen VW, Durako S. A collaborative study of differences in the survival rates of black patients and white patients with cancer. Cancer 1992;69:2349-2360.
Eley JW, Hill HA, Chen VW, Austin DF, Wesley MN, Muss HB, Greenberg RS, Coates RJ, Correa P, Redmond CK, Hunter CP, Herman AA, Kurman R, Blacklow R, Shapiro S, Edwards BK. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA 1994;272:947-954.
Mayberry RM, Coates RJ, Hill HA, Click LA, Chen VW, Austin DF, Redmond CK, Fenoglio-Preiser CM, Hunter CP, Haynes MA, Muss HB, Wesley MN, Greenberg RS, Edwards BK. Determinants of black/white differences in colon cancer survival. J Natl Cancer Inst 1995;87:1686-1693.
Hill HA, Eley JW, Harlan LC, Greenberg RS, Barrett RJ 2nd, Chen VW. Racial differences in endometrial cancer survival: the Black/White Cancer Survival Study. Obstet Gynecol 1996;88:919-926.
Chen VW, Fenoglio-Preiser CM, Wu XC, Coates RJ, Reynolds P, Wickerham DL, Andrews P, Hunter C, Stemmermann G, Jackson JS, Edwards BK. Aggressiveness of colon carcinoma in blacks and whites. National Cancer Institute Black/White Cancer Survival Study Group. Cancer Epidemiol Biomarkers Prev 1997;6:1087-1093.