Race as a Social Construct in Head and Neck Cancer Outcomes

Race as a Social Construct in Head and Neck Cancer Outcomes

Otolaryngology—Head Neck Surgery
Volume 144, Number 3 (March 2011)
pages 381-389
DOI: 10.1177/0194599810393884

Maria J. Worsham, PhD
Department of Otolaryngology/Head and Neck Surgery
Henry Ford Health System, Detroit, Michigan

George Divine, PhD
Biostatistics and Research Epidemiology
Henry Ford Health System, Detroit, Michigan

Rick A. Kittles, PhD
Section of Hematology/Oncology, Department of Medicine and Division of Epidemiology and Biostatistics
School of Public Health, University of Illinois, Chicago

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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