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African American Disparities in Breast Cancer

While breast cancer is less common in minorities, African American women may have more reason to be concerned than whites after a diagnosis of breast cancer.

Two studies published in the Journal of Clinical Oncology highlight a racial gap in breast cancer mortality and, while it is still unclear what role it plays in mortality rates, one finds that minorities in general are less likely to receive the best breast cancer treatment.

In the first study, researchers from the University of Michigan compared the mortality rates of over 14,000 African American women and 76,000 white women with breast cancer. After eliminating socioeconomic factors, they found that African American women are 19 times more likely to die from breast cancer than white women who have the same stage of cancer. This evidence disputes the common belief that African American women have lower survival rates because they are diagnosed later than whites.

"Much of the racial disparity in breast cancer mortality has been attributed to later diagnosis." wrote Dr. Nina A. Bickell, associate professor of health policy and medicine at Mount Sinai. "Yet, even within stage categories, mortality rates are higher for minority women."

In the study, Dr. Lisa Newman suggests that biologic, genetic, cultural and societal factors may cause higher mortality rates in African American women with breast cancer.

To further elucidate one possible cause for the higher mortality rates, Bickell looked at the use of adjuvant breast cancer treatment—chemotherapy given after surgery to kill any remaining cancer cells—in minority women with early-stage breast cancer. Adjuvant chemotherapy greatly reduces the risk of cancer recurrence and is considered to be the standard of care for patients after breast cancer surgery. Comparing treatment in 677 women with breast cancer, Bickell found that 34 percent of blacks and 23 percent of Hispanics were not given chemotherapy after surgery as compared to only 16 percent of whites.

"Our finding highlights just how much progress could be made to eliminate cancer death and suffering by closing the gap on racial disparities in breast cancer treatment." said Bickell.

While her study was conducted in New York City, where there is an abundance of care centers, Bickel believes that part of the reason minority women receive less care is that they are less likely to have health insurance. Additionally, these women were also found to be less likely to speak with an oncologist concerning their care.

"Instituting a required oncology consultation may reduce racial disparities in care." said Bickel, who further explained that better communication between patient and doctor would also help improve care for minorities with breast cancer.

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