Race as a social construct in head and neck cancer outcomes

Maria J. Worsham, George Divine, Rick A Kittles

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective. The authors examined ancestry informative markers (AIMs) to estimate the amount of population admixture and control for this heterogeneity for stage and survival in a primary head and neck squamous cell carcinoma (HNSCC) cohort. Study Design. Historical cohort study. Setting. Integrated health care system. Subjects. The cohort comprised 358 patients with HNSCC who self-reported race as Caucasian American (CA), African American (AA), or other. Methods. DNA was interrogated for West African (WA) and European genetic background by genotyping AIMs. Associations of race (self-report or WA ancestry) with stage and survival were analyzed using logistic regression and Cox regression modeling. A subgroup analysis for diagnosis (late vs early stage) and survival (time to death) and WA ancestry was performed for self-reported AAs. Results. There were significant associations between stage and self-reported race (P = .04 [univariate]) and with cancer site (oropharynx: P = .014; hypopharynx: P = .026 [multivariate]). For prognosis, there were significant multivariate associations between stage (P = .002), age (>65 years, P < .001), and cancer site (hypopharynx: P < .001; oral cavity: P = .049), but self-reported race was not associated with overall survival. Interestingly, there was no association with degree of WA ancestry and stage or survival. In the subgroup analysis of genetic ancestry among self-reported AAs, cancer site remained an independent risk factor for stage (other site: P = .026) and survival (oropharynx: P = .036). Late stage persisted as an independent variable for poor survival (P = .032). Conclusions. Stratification within AAs by WA ancestry revealed no correlation with stage or survival, suggesting that HNSCC outcomes with race may be owing to social/behavior factors rather than biological differences.

Original languageEnglish (US)
Pages (from-to)381-389
Number of pages9
JournalOtolaryngology - Head and Neck Surgery
Volume144
Issue number3
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Head and Neck Neoplasms
Survival
Hypopharynx
Integrated Delivery of Health Care
Oropharyngeal Neoplasms
Oropharynx
Population Control
Social Behavior
Delayed Diagnosis
Biological Factors
African Americans
Self Report
Mouth
Neoplasms
Cohort Studies
Logistic Models
DNA
Carcinoma, squamous cell of head and neck

Keywords

  • Ancestry informative markers (AIMs)
  • European ancestry
  • Genotyping
  • Self-report
  • Stage
  • Survival
  • West African (WA) ancestry

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

Cite this

Race as a social construct in head and neck cancer outcomes. / Worsham, Maria J.; Divine, George; Kittles, Rick A.

In: Otolaryngology - Head and Neck Surgery, Vol. 144, No. 3, 03.2011, p. 381-389.

Research output: Contribution to journalArticle

Worsham, Maria J. ; Divine, George ; Kittles, Rick A. / Race as a social construct in head and neck cancer outcomes. In: Otolaryngology - Head and Neck Surgery. 2011 ; Vol. 144, No. 3. pp. 381-389.
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abstract = "Objective. The authors examined ancestry informative markers (AIMs) to estimate the amount of population admixture and control for this heterogeneity for stage and survival in a primary head and neck squamous cell carcinoma (HNSCC) cohort. Study Design. Historical cohort study. Setting. Integrated health care system. Subjects. The cohort comprised 358 patients with HNSCC who self-reported race as Caucasian American (CA), African American (AA), or other. Methods. DNA was interrogated for West African (WA) and European genetic background by genotyping AIMs. Associations of race (self-report or WA ancestry) with stage and survival were analyzed using logistic regression and Cox regression modeling. A subgroup analysis for diagnosis (late vs early stage) and survival (time to death) and WA ancestry was performed for self-reported AAs. Results. There were significant associations between stage and self-reported race (P = .04 [univariate]) and with cancer site (oropharynx: P = .014; hypopharynx: P = .026 [multivariate]). For prognosis, there were significant multivariate associations between stage (P = .002), age (>65 years, P < .001), and cancer site (hypopharynx: P < .001; oral cavity: P = .049), but self-reported race was not associated with overall survival. Interestingly, there was no association with degree of WA ancestry and stage or survival. In the subgroup analysis of genetic ancestry among self-reported AAs, cancer site remained an independent risk factor for stage (other site: P = .026) and survival (oropharynx: P = .036). Late stage persisted as an independent variable for poor survival (P = .032). Conclusions. Stratification within AAs by WA ancestry revealed no correlation with stage or survival, suggesting that HNSCC outcomes with race may be owing to social/behavior factors rather than biological differences.",
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