WHY are black women 40 percent more likely to die of breast cancer than white women?
Differences at diagnosis, not differences in treatment reasons for discrepancy, experts say
It's a somewhat shameful medical fact that in the United States, black women are 40 percent more likely to die of breast cancer than white women. Furthermore, the 20-year-long divide in breast cancer survival rates among black and white women hasn't changed. Experts now say that the difference is driven more on how sick women are when they come in for a diagnosis rather than the differences in how they're treated.
Researchers also accounted for how sick the patients were when first diagnosed, the black-white difference in survival dropped to 4.4 percent, meaning two-thirds of the difference was because of how sick patients were at diagnosis.
Researchers have been perplexed as to why the racial disparity exists. Some have suggested the differences in screening, existing health problems, socioeconomic status and treatment.
A new study, published in the Journal of the American Medical Association, now says that the low survival rate can't be explained solely by the types and frequency of treatment.
Characteristics at diagnosis explain the differences in survival, not differences in the type, duration and frequency of treatment. Black patients had poorer health at diagnosis, including more advanced disease, worse biological features of the disease and larger tumor size.
"Can you blame the oncologists? Probably not. But what we are saying is that in order to improve diagnoses, we have to turn to primary care," Jeffrey Silber, study author and director of the Center for Outcomes Research at the Children's Hospital of Philadelphia says. "This is an issue of prevention."
Breast cancer is the second-leading cause of cancer deaths among women after lung cancer. Breast cancer deaths occur in about one in 36 women in the United States each year. However, death rates have been declining since the 1980s as a result of earlier detection through screening. However, they have leveled off in recent years.
Researchers in the study compared five-year survival rates of more than 7,000 black women over 65 with three sets of white women who were matched on factors such as year of diagnosis, state of their health upon diagnosis and the state of their tumors.
The study also examined treatment such as surgery, radiation therapy and chemotherapy. The women were all insured by Medicare to eliminate any effect from socioeconomic background.
Overall five-year survival rates were 55.9 percent for black women and 68.8 percent for whites, a 12.9 percentage point difference.
Researchers also accounted for how sick the patients were when first diagnosed, the black-white difference in survival dropped to 4.4 percent, meaning two-thirds of the difference was because of how sick patients were at diagnosis. Looking further at treatment, as well as their condition at time of the diagnosis, dropped the difference to 3.6 percent.
"Therefore, the overall survival disparity is greatly influenced by how sick patients are at diagnosis, but only trivially influenced by differences in treatment," Silber says.
Reducing the disparity in survival rates means reducing the differences in how sick patients are when first diagnosed, Silber says. "Reducing treatment disparities, while important, will not solve the survival disparity problem. We must find ways to have black patients present at diagnosis ... with less advanced disease, smaller tumors and with less chronic conditions like diabetes and heart failure, all of which lead to worse survival."
© 2013, Distributed by NEWS CONSORTIUM.
Pope Francis Prayer Intentions for December 2013
General Intention: Victimized Children. That children who are victims of abandonment or violence may find the love and protection they need.
Missionary Intention: Prepare the Savior's Coming. That Christians, enlightened by the Word incarnate, may prepare humanity for the Savior's coming.
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