Income Don’t Explain ‘Race Gap’ in Breast Cancer Care
The racial divide the attention of breast cancer has long been known to researchers, with black and Hispanic women less likely to recommend treatments for breast cancer than white patients.
“Less well known is what is the problem – is that the race itself or something to contribute more?” Said Dr. Rachel Freedman, a medical oncologist at Dana Farber Cancer Institute in Boston and an instructor of medicine at Harvard Medical School.
His team new study suggests that financial factors such as economic and social class or access to insurance alone can not explain the “gap”: Even after accounting for differences, racial disparities in breast cancer care yet presented.
The study, published online Oct. 11 in the journal Cancer, “was unique because it included adult women of all ages, and included [those of] insurance,” said Freedman.
Freedman evaluated data on more than 662,000 white women, black and Hispanic diagnosed with invasive breast cancer 1998 to 2005. We used U.S. data the National Database of Cancer, a record that contains information about the treatment of patients, the results, insurance and socioeconomic status.
In the database, 86 percent of women were white, 10 percent black and 4 percent Hispanic.
When assessing whether women have the right treatment and testing, the researchers found no differences by race / ethnicity to the hormone receptor test (to assess whether a cancer is estrogen receptor positive or negative, that could help guide treatment .)
But they did find differences in other interventions. For example, black women were less likely to get recommended treatments – interventions such as mastectomy or conservative surgery, chemotherapy and hormonal therapy (such as aromatase inhibitors to reduce the risk of recurrence), Freedman said. And Hispanic women are less likely than whites to receive hormonal therapy.
Liberto that black women are 9 percent less likely than whites to get a mastectomy, breast conservation surgery, or other treatments, 10 percent less likely to receive hormonal therapy and 13 percent less likely to receive chemotherapy.
Importantly, these disparities persist even after the researchers accounted for insurance coverage and socioeconomic status. “In this study, even those with the same sure, there were gaps career,” said Freedman.
“More research is needed,” he said, “to find out what factors [other] make sense.”
Freedman said the study has limitations, including his discovery of the relatively small absolute differences in the care of different types of patients who received. Still, since breast cancer is often diagnosed, these small differences would eventually affect a large number of women, he said.
While the database was large, the information was not always complete. The missing information for many women. For example, more than 46,000 women were excluded from the analysis of chemotherapy, because data was missing.
One expert agreed that a gap in care associated with race seems to persist.
Despite the limitations of the study “makes it seem racial differences still exist, but tempered somewhat by insurance and socioeconomic status,” said Dr. Nina Bickel, associate professor of health policy and medicine, Mount Sinai School of Medicine in New York.
But for women of any race diagnosed with breast cancer, the message is the same, said Bickel. “I would say to someone who should be receiving the information, and there are plenty of relevant information available to people with breast cancer.”
“Get it from reliable sources,” she said, as the American Cancer Society.
It also recommends that women diagnosed with breast cancer to write a list of questions before going on a trip to the doctor, take a friend or relative with them to help them understand the options and consider taking a tape recorder so that information can be replayed later.
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