Researchers say there appears to be evidence of racial differences in treatment of breast cancer among women under 50, since survival rates by stage-at-diagnosis for younger black women are lower than for white women. The study is published in the journal Cancer.

The authors observed that 6-year survival rates were significantly lower for black women less than 50 years old for identical stage and estrogen receptor (ER) status cancers. No significant racial differences in the stage-specific survival rates were found for women 65 years and older, suggesting that Medicare may help alleviate racial disparities in cancer treatment. Black women of all ages were diagnosed at later stages of breast cancer compared to white women, indicating the need for more early diagnosis for black women of all ages.

The difference in survival among black women with breast cancer and later stage at diagnosis implicate racial differences in access to healthcare resources. The authors conclude, "the structural barriers may be overcome by offering health insurance" to provide equal access to treatment "and by providing information to physicians and patients" about effective screening and treatment options.

Racial differences in breast cancer survival are often studied but not well understood. Repeated analyses have shown that black women are diagnosed at a more advanced stage than white women, resulting in lower long-term survival rates. Some studies point to race being an independent prognostic factor even after adjustment for clinical and socioeconomic factors. However, disparities in screening and treatment may be a more significant contributing factor.

Previous studies have shown that black women were less likely to receive screening mammograms and less likely to receive the same treatment as white women, such as surgery or radiation, for the same stage and ER-type cancer. When racial cancer management differences are addressed, clinical trials show equal stage-specific survival rates for black and white women with breast cancer.

To identify racial differences in treatment, Chu et al examined differences in black and white stage-specific survival rates, which are affected by post-diagnosis factors such as treatment, and their relationship with ER status, which also determines the treatment protocol. They examined breast cancer data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute for the period of 1992 to 1999.

Overall, the 6-year stage-specific survival rates are significantly lower for black women of all ages compared to white women. However, further analysis shows that age and ER status of the cancer are important factors to this racial disparity in survival. Black women less than 50 years old with ER-positive cancers have significantly lower 6-year survival rates than white women. In contrast, for women 65 and over, there are no significant stage-specific survival rate differences between the black and white women. This may suggest that Medicare may help alleviate racial disparities in breast cancer treatment.

The authors suggest that barriers to optimal treatment may lie in "structural factors," that affect access to medical care, such as insurance and health care facilities, and "information issues," such as physician-patient education, that can affect the utilization of the medical care. Medicare may alleviate both these barriers by offering health insurance to many. Physicians and patients learn about the coverage providing a financial incentive for removing the information barriers.

Black women have less early stage (stage I - III) breast cancers than white women, regardless of age and ER status. That there is a real skewing of breast cancer in black women toward higher stages indicates to the authors "that black females of every age need more early diagnosis." The authors conclude, "racial differences in stage-specific survival rates vary by age and ER status," suggesting racial differences in treatment options for young black women, possible benefits of Medicare for older black women, and the need for early diagnosis for all black women.

SOURCE:
Cancer, June 1, 2003