Evidence map›Paper›PMID 34001038›Full record

ArticleBMC cancer2021

The Will Rogers phenomenon, breast cancer and race.

Mary R Nittala, Eswar K Mundra, S Packianathan, Divyang Mehta, Maria L Smith, William C Woods, Shawn McKinney, Barbara S Craft, Srinivasan Vijayakumar

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In one paragraph

Article in BMC cancer, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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  3. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mary R NittalaDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA. mnittala@umc.edu.ORCID http://orcid.org/0000-0002-9755-5672
Eswar K MundraDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA.
S PackianathanDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA.
Divyang MehtaDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA.
Maria L SmithDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA.
William C WoodsDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA.
Shawn McKinneyDepartment of Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
Barbara S CraftDepartment of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Srinivasan VijayakumarDepartment of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson, Jackson, MS, 39213, USA. svijayakumar@umc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients' group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP.

methodsThis is a retrospective analysis of 300 BC women (2007-2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes.

resultsOur patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004).

conclusionThe WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.

Indexed as

Breast NeoplasmsAcademic Medical CentersAdultAgedAged, 80 and overBlack or African AmericanBreastDisease-Free SurvivalFemaleFollow-Up StudiesHealth Status DisparitiesHumansKaplan-Meier EstimateMiddle AgedMississippiNeoplasm GradingBreast cancerRacial disparitiesWill Rogers phenomenon

Identifiers

PMID34001038
PMCPMC8127271

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.