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Black Women Get Less Breast Cancer Treatment

Section: Health

Kathleen Doheny

Black women with breast cancer that has spread to the lymph nodes are less likely to undergo supplemental, potentially lifesaving, therapies such as tamoxifen or chemotherapy than white women with the same level of disease are, a new study finds.

"When cancer has spread to the lymph nodes, we are seeing that African-American women are not getting the optimal therapy as often as are Caucasians," said study author Mousumi Banerjee, a research associate professor at the University of Michigan School of Public Health, in Ann Arbor.

The study is published online Oct. 8 and is expected to be published in the Nov. 15 issue of Cancer.

Banerjee's team reviewed final data on 630 women diagnosed with breast cancer at the Karmanos Cancer Institute in Detroit between 1990 and 1996. They wanted to evaluate the role of race in breast cancer treatment, after accounting for such variables as any accompanying illnesses (some of which might have ruled out the use of certain treatments), as well as the women's socioeconomic and health insurance status.

Of the 630 women, 242 were white and 388 were black. Of the 242 white women, 154 had local disease, while in 88, it had spread to the lymph nodes. Of the 388 black women, 230 had local tumors, and 158 had disease that had spread to the lymph nodes.

Among the patients whose cancer had reached their lymph nodes, black women were less likely to have supplemental therapy. White women whose cancer had also spread to the nodes were nearly five times as likely as blacks to take tamoxifen, the cancer-preventing drug, and more than three times as likely to take chemotherapy.

The researchers also found that those with early stage breast cancer who were in government health insurance plans were less likely to have breast-conserving surgery (meaning less than a full mastectomy) and radiation and more likely to have mastectomy.

The black women were more likely to be older, unmarried, and to have more chronic diseases, the team found. Banjeree also found that women whose cancer had spread to the lymph nodes were more likely to receive supplemental treatments if they were married, regardless of their race.

Among the women with local-stage disease that had not reached the lymph nodes, the rates of the supplemental therapy were similar between blacks and whites, she found.

The new research adds information to the body of knowledge about ethnic differences in cancer and cancer care, the lead author said. For years, researchers have known that blacks are more likely to die from breast cancer than are white women. A couple of hypotheses have been touted to explain why, she said.

Some experts have speculated that the differences are due to variance in socioeconomic status, accompanying diseases and access to care, Banerjee said. Others believe there's something about tumor biology -- that breast cancer may differ among women of different races. Still others think it's a bit of both, she said.

Banerjee said her study focused on treatment, looking to see if race-associated differences existed in women with essentially the same type and stage of cancer.

The study adds valuable information to what is known about ethnic differences in breast cancer, said Dr. Gloria Morris, assistant professor of medicine in the department of medical oncology at Kimmel Cancer Center, part of Thomas Jefferson University Hospital in Philadelphia.

"Other studies have found treatment delays between races," she said. According to Morris, the take-home message here is that, "early detection is important so breast cancer can be caught at an early stage -- local instead of what this study refers to as regional stage, where cancer has reached the lymph nodes."

"It's also extremely important to have a good [patient] support system, to have equivalent access to care and certainly social intervention programs," Morris added.

Banerjee said the research points to the need for more educational interventions, so that all women understand their treatment options.

For women, her advice is to then "make a decision about the therapy, based on the factors that really affect survival."

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