Cancer Advances: Two Studies Shed Light on Ethnic Disparities in Breast Cancer Treatment and Mortality

Posted online March 20, 2006 on www.jco.org

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Two studies published in the March 20 issue of the Journal of Clinical Oncology provide new insight into ethnic disparities in breast cancer treatment and mortality.The first study shows that African-American women are nearly 20 percent more likely than white women to die of breast cancer, even after controlling for socioeconomic status. A second study finds that minority women are half as likely to receive recommended adjuvant treatment (treatment following surgery) for the disease, which may in part explain the disparity in breast cancer deaths among African Americans.

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The first study by researchers at the University of Michigan examined whether factors other than socioeconomic status contribute to the high rate of breast cancer death among African-American women. Researchers reviewed data from 20 previously completed breast cancer studies that included information on patient survival, ethnicity, and socioeconomic status. Controlling for socioeconomic status, researchers found that African-American ethnicity itself was a factor associated with poor breast cancer outcome.

The study found that when controlling for socioeconomic status and cancer stage, African-American women were still 19 percent more likely to die from breast cancer than white women.Researchers underscored the need to investigate the role of biologic, genetic, and sociocultural factors in breast cancer mortality among black women.

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A second study by researchers at the Mount Sinai School of Medicine found that minority women are half as likely as white women to receive the recommended adjuvant treatment. Adjuvant treatment involves the use of radiation, chemotherapy, or hormonal therapy following breast cancer surgery.

Researchers reviewed medical records of 677 women who underwent surgery for early-stage breast cancer at one of six New York City-area hospitals in 1999 and 2000. Researchers analyzed the records to identify cases where adjuvant chemotherapy was underutilized and examined the rates of underuse by ethnic group.

Researchers found that minority women with early-stage breast cancer had double the risk of white women for failing to receive adjuvant treatment, despite similar rates of referral to oncologists.

Overall, the likelihood of underuse of adjuvant treatment was 16 percent among white women, 23 percent among Hispanic women, and 34 percent among African-American women.

Researchers found that minority women were more likely to have other illnesses and less insurance than white women and suggested that these factors could influence a physician's decision to prescribe—or a patient's decision and ability to receive—adjuvant treatment.

What Does This Mean for Patients?

Adjuvant therapy for breast cancer—treatment with radiation, chemotherapy, or hormone therapy following surgery—helps to prevent recurrence of the disease by destroying cancer cells near the tumor site or in other parts of the body that were not removed by the surgery.

Generally, adjuvant treatment for breast cancer involves radiation for women who have undergone breast-conserving surgery, and a combination of chemotherapy and/or hormone therapy for women who have breast cancers that are sensitive to estrogen (hormone-receptor positive) and those whose cancers are not (hormone-receptor negative).

Because adjuvant therapy can reduce breast cancer recurrence and improve survival, all women who have been diagnosed with breast cancer should talk with their oncologists about potential treatment options following surgery for their disease. This is particularly important for African-American and Hispanic women, who have historically been less likely to receive adjuvant therapy, and are more likely to die of their disease.

Helpful Links

For more information on the diagnosis and treatment of breast cancer including staging illustrations, visit www.plwc.org/breast.

Last Updated: March 20, 2006