TY - JOUR
T1 - Racial Disparities in the Clinical Presentation and Prognosis of Patients with Mycosis Fungoides
AU - Huang, Amy H.
AU - Kwatra, Shawn G.
AU - Khanna, Raveena
AU - Semenov, Yevgeniy R.
AU - Okoye, Ginette A.
AU - Sweren, Ronald J.
N1 - Funding Information:
None. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The abstract was presented as an oral presentation at the Skin of Color Society Research Symposium 2019. Financial Disclosures: Dr. Kwatra is an advisory board member for Menlo and Trevi Therapeutics. None of the other authors have any conflicts of interest to disclose. Obtained funding: None.
Publisher Copyright:
© 2019 National Medical Association
PY - 2019/12
Y1 - 2019/12
N2 - Objective: Racial and gender disparities in mycosis fungoides (MF) are understudied. The objective of this study was to test the hypothesis that worse prognosis in blacks with MF is mediated by higher disease stage at diagnosis and by earlier disease onset in black females. Methods: We conducted retrospective chart review of 337 patients with clinically-suspected MF seen at Johns Hopkins between 2003 and 2018, requiring biopsy-proven disease for study inclusion. Patient demographics, initial stage/percent body surface area (BSA) involvement, pathology type, flow cytometry results, and treatment regimens were recorded. Results: Of 303 patients with confirmed MF, 166 (55%) were white, 107 (35%) black, 10 (3.3%) Middle Eastern, 6 (2.0%) Asian, and 14 (4.6%) Hispanic/other. Blacks were 3 times as likely (95% CI: 1.2, 8.0) to have Stage 2 disease to have Stage 2 disease at diagnosis as compared to whites as whites. In females, blacks were younger at diagnosis (p = 0.003) and at death (p = 0.008) compared to whites. In males, blacks had 4 times the odds of late-stage disease (p = 0.017) and presented with 19% greater BSA involvement on average compared to whites (p < 0.001). Conclusions: Compared to their white counterparts in this cohort, black males were diagnosed with MF at a higher stage with greater skin involvement while black females were diagnosed and died earlier. Earlier recognition of MF in skin of color and closer follow-up of black females with early-onset, aggressive disease may help to mitigate disparities in outcomes.
AB - Objective: Racial and gender disparities in mycosis fungoides (MF) are understudied. The objective of this study was to test the hypothesis that worse prognosis in blacks with MF is mediated by higher disease stage at diagnosis and by earlier disease onset in black females. Methods: We conducted retrospective chart review of 337 patients with clinically-suspected MF seen at Johns Hopkins between 2003 and 2018, requiring biopsy-proven disease for study inclusion. Patient demographics, initial stage/percent body surface area (BSA) involvement, pathology type, flow cytometry results, and treatment regimens were recorded. Results: Of 303 patients with confirmed MF, 166 (55%) were white, 107 (35%) black, 10 (3.3%) Middle Eastern, 6 (2.0%) Asian, and 14 (4.6%) Hispanic/other. Blacks were 3 times as likely (95% CI: 1.2, 8.0) to have Stage 2 disease to have Stage 2 disease at diagnosis as compared to whites as whites. In females, blacks were younger at diagnosis (p = 0.003) and at death (p = 0.008) compared to whites. In males, blacks had 4 times the odds of late-stage disease (p = 0.017) and presented with 19% greater BSA involvement on average compared to whites (p < 0.001). Conclusions: Compared to their white counterparts in this cohort, black males were diagnosed with MF at a higher stage with greater skin involvement while black females were diagnosed and died earlier. Earlier recognition of MF in skin of color and closer follow-up of black females with early-onset, aggressive disease may help to mitigate disparities in outcomes.
KW - Disparities
KW - Gender
KW - Mycosis fungoides
KW - Race
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U2 - 10.1016/j.jnma.2019.08.006
DO - 10.1016/j.jnma.2019.08.006
M3 - Article
C2 - 31623818
AN - SCOPUS:85073566578
SN - 0027-9684
VL - 111
SP - 633
EP - 639
JO - Journal of the National Medical Association
JF - Journal of the National Medical Association
IS - 6
ER -