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Open Access Publications from the University of California

Breast Cancer Characteristics in Middle Eastern Women Immigrants Compared With Non-Hispanic White Women in California.

  • Author(s): Ziadeh, Clara
  • Ziogas, Argyrios
  • Jiang, Luohua
  • Anton-Culver, Hoda
  • et al.


Emerging evidence has indicated that Middle Eastern (ME) immigrants might be more likely to be diagnosed with breast cancer at advanced stage, yet have better overall survival than nonimmigrant non-Hispanic whites (NHW). This study aims to analyze the association between ME immigration status and breast cancer stage at diagnosis and survival.


Using the California Cancer Registry, a total of 343 876 women diagnosed with primary in situ or invasive breast cancers were identified during 1988-2013. Multinomial logistic regression models were fitted to evaluate the risk of in situ and nonlocalized breast cancer stage in comparison with localized breast cancer among first-generation ME immigrants, second- or subsequent-generation ME immigrants, and NHW. Cox proportional hazard models were applied to calculate hazard ratios (HRs) with their 95% confidence intervals (CIs) for breast cancer mortality among the three population groups with invasive primary breast cancer.


First-generation ME immigrants had higher odds of being diagnosed with a nonlocalized stage (vs localized) than NHW (odds ratio [OR] = 1.17, 95% CI = 1.09 to 1.26). Second- or subsequent-generation ME immigrants also had higher odds of being diagnosed with a nonlocalized stage (vs localized) than NHW (OR = 1.31, 95% CI = 1.20 to 1.43). First-generation ME immigrants were 11% less likely to die from breast cancer than NHW (HR = 0.89, 95% CI = 0.82 to 0.97).


First-generation ME immigrants had higher breast cancer survival despite being diagnosed at a nonlocalized breast cancer stage at diagnosis when compared with NHW. Screening interventions tailored to this ME immigrant group need to be implemented.

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