Researchers have long known that African-American women are more likely than white women to have late-stage breast cancer at diagnosis and a shorter survival time. But it has been unclear whether these differences are because of race or socioeconomic status.
To find out, Bradley and her coworkers linked Detroit cancer registry data with Medicaid enrollment files and found 5,719 women with breast cancer. Of those, 593 were insured by Medicaid and had income levels below the federal poverty line. The rest of the women had other forms of insurance or were uninsured.
The authors found that, compared with white women, African-American women were 53% more likely than white women to be diagnosed with later-stage disease, 26% less likely to receive radiation after breast-conserving surgery, more than twice as likely to receive no surgery, and 39% more likely to die.
But when the authors adjusted their data to account for race and socioeconomic factors, differences in these outcomes, except for choice of surgery, nearly vanished. Compared with white women, African-American women were 62% more likely to have no surgery. If the African-American women had surgery, they were 63% more likely to receive breast-conserving surgery.
Women insured by Medicaid were 41% more likely to be diagnosed with late-stage breast cancer, 44% less likely to receive radiation after breast-conserving surgery, and three times more likely to die than women not insured by Medicaid.
The authors conclude that, “poor persons, regardless of their race, are likely to have undesirable cancer outcomes. This finding should challenge the research and policy communities to provide remedies for reducing these disparities.”
In an editorial, Otis Brawley, M.D., of the Winship Cancer Institute, Emory University, notes that the disparity in breast cancer mortality rates between black and white women has continued to increase every year for the past 20 years. “Finding the true reasons for the disparity is important if we are to effectively reduce it,” he says.
Brawley points out that the new study helps focus the issue on poverty: “Rather than speaking in racial/ethnic terms of black and white populations, it is more appropriate to speak in socioeconomic terms of the ‘haves’ and ‘have nots.’ This focus would rightfully bring other socioeconomically deprived populations that include whites, Hispanics, Native Americans, and Asians into the discussion.”
Contact: Tom Oswald, Michigan State University, (517) 432-0920; fax: (517) 353-5368, Oswald@msu.edu
Editorial: Vincent Dollard, Winship Cancer Institute, (404) 778-4580; fax: (404) 778-5048, Vincent_dollard@emoryhealthcare.org
Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 2002;94:490–6.
Editorial: Brawley OW. Disaggregating the effects of race and poverty on breast cancer outcomes. J Natl Cancer Inst 2002;94:471–3.
Attribution to the Journal of the National Cancer Institute is requested in all news coverage.
Journal
JNCI Journal of the National Cancer Institute