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Race/ethnicity and breast cancer estrogen receptor status: impact of class, missing data, and modeling assumptions

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Abstract

Objective

To test whether reported associations between race/ethnicity and breast cancer estrogen receptor (ER) status are inflated due to missing ER data, lack of socioeconomic data, and use of the odds ratio (OR) rather than the prevalence ratio (PR).

Methods

We geocoded and added census tract socioeconomic data to all cases of primary invasive breast cancer (n = 42,420) among women diagnosed between 1998 and 2002 in two California cancer registries (San Francisco Bay Area; Los Angeles County) and analyzed the data using log binomial regression.

Results

Adjusting for socioeconomic position and tumor characteristics, in models using the imputed data, reduced the PR for the black versus white excess risk of being ER− from 1.76 (95% CI: 1.66, 1.86; adjusted for age and catchment area) to 1.47 (95% CI: 1.38, 1.56). The latter parameter estimate was 16% greater (i.e., 1.56) in models excluding women with missing ER data, and was 43% greater when estimated using the OR (i.e., 1.82).

Conclusion(s)

Studies on race/ethnicity and ER status that fail to account for missing data and socioeconomic data and report the OR are likely to yield inflated estimates of racial/ethnic disparities in ER status.

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Acknowledgments

The authors gratefully acknowledge, with permission granted on 20 December 2007, the contributions of Pamela D. Waterman, MPH and Ruihua Yin, MS for their initial work helping to prepare the database used for this study.

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Authors and Affiliations

  1. Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 717, Boston, MA, 02115, USA

    Nancy Krieger

  2. Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Jarvis T. Chen

  3. Dean for Academic Affairs and Development of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    James H. Ware

  4. Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Afamia Kaddour

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  1. Nancy Krieger
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  2. Jarvis T. Chen
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  4. Afamia Kaddour
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Correspondence to Nancy Krieger.

Additional information

This investigation was funded by NIH grant 1 R03 CA125839-01, issued by the National Cancer Institute.

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Krieger, N., Chen, J.T., Ware, J.H. et al. Race/ethnicity and breast cancer estrogen receptor status: impact of class, missing data, and modeling assumptions. Cancer Causes Control 19, 1305–1318 (2008). https://doi.org/10.1007/s10552-008-9202-1

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