Cancer Advances: African Americans Half as Likely to Receive Surgery for Esophageal Cancer

Posted online on January 19, 2005 on www.jco.org.Read the original studyA new study shows that African-Americans patients with esophageal cancer are less likely than white patients to be seen by a surgeon and to receive life-prolonging surgery. The study, which examined racial differences in access to surgery among older patients with esophageal cancer, found that only 25% of African-American patients received potentially curative surgery, compared to 46% of white patients. The study will be published January 20 in the Journal of Clinical Oncology.Researchers at the Dana Farber Cancer Institute in Boston reviewed medical records from 2,946 white patients and 367 African-American patients with esophageal cancer ages 65 and older. In comparison to white patients, African-American patients were slightly younger, had a lower socioeconomic status, and had more pre-existing health conditions, such as heart disease and diabetes. African-American patients were also more likely to have squamous cell cancer, which typically arises in the middle or upper part of the esophagus.To better understand why blacks are less likely to undergo surgery, researchers examined the number of black and white patients who were ever assessed by a surgeon, and the rate of surgery among those who met with a surgeon.Researchers found that 70% of African-American patients were assessed by a surgeon, compared to 78% of white patients. Among the 258 African-American patients who received an evaluation for surgery, only 35% underwent surgery, compared to 59% of 2,307 white patients. Researchers noted that age, socioeconomic status, and pre-existing health conditions only partly explained why black patients were less likely to be evaluated by a surgeon and to receive surgery once evaluated.African American esophageal cancer patients in the study were also less likely to survive than white patients. Two years after diagnosis, 18% of African-American patients were alive, compared to 25% of white patients. However, when African Americans received surgery, they experienced similar survival rates to white patients who had undergone surgery.Researchers also noted that African Americans were generally undertreated for esophageal cancer. Twenty percent of African-American patients received radiotherapy as their only treatment and 26% received no therapy at all, compared to 13% and 15% of white patients, respectively.What Does This Mean for Patients?Surgery is the most common form of treatment for esophageal cancer. Almost 20% of patients with esophageal cancer will survive at least five years after surgery.Patients with esophageal cancer should talk with their physicians about treatment options, the potential risks and benefits of surgery, and the importance of being evaluated by a surgeon prior to surgery.