Researchers Find Disparities in Breast Cancer Outcomes for African-Americans
Researchers at the University of Miami Miller School of Medicine have found that dramatic disparities in breast cancer outcomes continue to exist for African-American women, regardless of the age at which they are diagnosed, extent of the cancer, type of treatment or socioeconomic status. The study is published in the May issue of the Journal of the American College of Surgeons and represents the largest population-based analysis of breast cancer outcomes data to date, and includes more than 60,000 patients in the state of Florida.
Government programs to improve access to breast cancer screening and treatment have been in place for nearly two decades, but African-American women continue to suffer a high breast cancer mortality rate. This disparity is even more striking because the incidence of breast cancer in this population is lower than in Caucasian women.
The research indicates that breast cancer outcomes for African-American women might be improved by lowering the recommended age of initial screening from 40 years to 33 years, the age at which the percentage of African-American women who develop breast cancer is similar to the percentage of Caucasian women in whom the disease develops under 40 years of age.
“Current screening guidelines are not sufficient in detecting breast cancer in African-American patients because the disease has already developed in over 10 percent of these women by age 40,” said Leonidas G. Koniaris, M.D., associate professor in the DeWitt Daughtry Family Department of Surgery, and surgical oncologist at the Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. “However, even with earlier diagnosis, our analysis uncovered serious socioeconomic barriers that prevent many African-American women with breast cancer from receiving the latest, most specific treatments.”
The study came about following a collaboration with Judith Hurley, M.D., associate professor of medicine and oncologist with the Braman Family Breast Cancer Institute at Sylvester. Koniaris and Hurley developed the idea for a study examining the effects of race and poverty on breast cancer outcomes. Surgical residents at the Miller School, Michael Cheung, M.D., and Relin Yang, M.D., took part in the study, analyzing the collected data.
The analysis examined more than 63,000 patients with invasive breast cancer using the Florida Cancer Data System and data from the state’s Agency for Health Care Administration. More than half of those in the study, nearly 60 percent, lived at or below 10 percent of the federal poverty level.
African-American patients presented with breast cancer at a younger age and a more advanced stage. Approximately 72 percent of African-American women were diagnosed before the age of 65, in comparison with 50 percent among Caucasian women. Just over half of African-American women were diagnosed with disease that had not spread, while far more (68 percent) of Caucasian women presented with localized disease. In addition, metastatic disease was seen nearly twice as often in African-American women when compared with Caucasian women. Overall, African-American women had a significantly lower overall five-year survival rate compared with Caucasian women.
When it came to treatments, more differences were found for African-American women. These patients were less likely than Caucasian women to undergo surgical therapy. In addition, for those who did have surgery, survival rates for African-American women were still considerably lower than for Caucasian women. Similarly, African-American patients who received nonsurgical therapy, including chemotherapy, had a lower rate of survival compared with Caucasian patients who received similar treatments.
Koniaris and his team identified a significant decrease in the risk of death observed for African-American patients upon adjustment for stage of presentation, suggesting that disparities in breast cancer outcomes are, in part, a result of advanced stage at diagnosis.
Researchers also identified socioeconomic status as an independent predictor of poor breast cancer outcomes. Patients in the lowest socioeconomic status category were diagnosed with higher rates of metastatic disease than patients in the higher-income categories. Patients of low socioeconomic status were treated less frequently with surgical therapy. Five-year survival was statistically decreased as poverty level increased for all types of treatment, whether surgical or nonsurgical.