ABSTRACT
BACKGROUND: Surgical-treatment outcomes for melanoma in African Americans are poorly characterized as a result of low incidence of melanoma among African Americans. We examined differences by race in overall and melanoma-specific survival, stratified by receipt of surgical treatment and by specific types of surgical treatment. METHODS: Data from the 1973-2004 public-use Surveillance, Epidemiology and End Results Program (SEER) were analyzed by Cox proportional hazard models to compare the effects of surgical treatments on overall and melanoma-specific survival in blacks, whites, and other race, controlling for confounding demographic and tumor-related variables. RESULTS: Of 151,154 patients with first primary melanoma (148,883 whites, 789 blacks and 1,532 other race), 142,653 (94.4%) received surgical treatment. Among patients who received surgical treatment, 10-year melanoma-specific survival was lower in blacks (73%) than in whites (88%) and other race (85%); black patients were at significantly higher risk of overall and melanoma-specific mortality when compared with white (hazard ratio [HR] = 1.64, 95% confidence interval [CI] 1.44-1.86, P < 0.0001 and HR = 1.50, 95% CI 1.25-1.79, P < 0.0001, respectively) and with other race (HR = 1.55, 95% CI 1.31-1.85, P < 0.0001 and HR = 1.49, 95% CI 1.16-1.91, P = 0.0017, respectively). Blacks who underwent biopsy, wide excision and surgery not otherwise specified were at higher risk of overall mortality compared with whites with the same treatment. CONCLUSION: Overall and melanoma-specific survival was lower in blacks undergoing surgical treatment for melanoma compared to both whites and other race. Reasons for these disparities remain poorly understood.
Subject(s)
Black People/statistics & numerical data , Melanoma/ethnology , Melanoma/mortality , Skin Neoplasms/ethnology , Skin Neoplasms/mortality , White People/statistics & numerical data , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Melanoma/surgery , Middle Aged , Prognosis , Retrospective Studies , SEER Program , Skin Neoplasms/surgery , Survival RateABSTRACT
We examined the impact of surgical treatments (breast-conserving surgery [BCS], mastectomy alone, mastectomy with reconstruction) and surgical side-effects severity on early stage (0-IIA) breast cancer patients' body image over time. We interviewed patients at 4-6 weeks (T1), six (T2), 12 (T3), and 24 months (T4) following definitive surgical treatment. We examined longitudinal relationships among body image problems, surgery type, and surgical side-effects severity using the Generalized Estimating Equation approach, controlling for demographic, clinical, and psychosocial factors. We compared regression coefficients of surgery type from two models, one with and one without surgical side-effects severity. Of 549 patients enrolled (mean age 58; 75% White; 65% BCS, 12% mastectomy, 23% mastectomy with reconstruction), 514 (94%) completed all four interviews. In the model without surgical side-effects severity, patients who underwent mastectomy with reconstruction reported poorer body image than patients who underwent BCS at T1-T3 (each P < 0.02), but not at T4. At T2, patients who underwent mastectomy with reconstruction also reported poorer body image than patients who underwent mastectomy alone (P = 0.0106). Adjusting for surgical side-effects severity, body image scores did not differ significantly between patients with BCS and mastectomy with reconstruction at any interview; however, patients who underwent mastectomy alone had better body image at T2 than patients who underwent mastectomy with reconstruction (P = 0.011). The impact of surgery type on body image within the first year of definitive surgical treatment was explained by surgical side-effects severity. After 2 years, body image problems did not differ significantly by surgery type.
Subject(s)
Body Image , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/surgery , Mammaplasty , Mastectomy , Plastic Surgery Procedures , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/psychology , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/psychology , Female , Follow-Up Studies , Humans , Mastectomy, Segmental , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Prospective Studies , Quality of LifeABSTRACT
The Doubles, funded by the National Institute on Drug Abuse, is a seven-episode series of media tools designed to teach third and fourth grade students about the science of drug addiction. The program's curriculum is delivered via a set of videos, interactive CD-ROMs, workbooks, or an Internet site. This article examines the process used to develop The Doubles and argues that its success stems from the careful balancing of the needs of the funding agency, state and national curricular guidelines, and the target audience.
