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June 5, 2007 (Chicago) -- The racial disparity in the treatment of women with breast cancer appears to be worsening, researchers report.
A two-decade study shows that while white women with advanced breast cancer are living longer than ever, survival rates among black women haven’t changed.
The result: a widening gap between the races, says researcher Sharon Giordano, MD, MPH, an assistant professor of breast medical oncology at the University of Texas M.D. Anderson Cancer Center in Houston.
In 2007, about 180,000 American women will be diagnosed with breast cancer, up to 10% of whom already have metastatic breast cancer that has spread to other parts of the body at the time of diagnosis.
In general, these women can expect to live only 18 to 24 months, she says.
Giordano says a previous study at M.D. Anderson showed that survival rates among women with metastatic breast cancer have improved over the past decade. The new study aimed to look more closely at trends and factors affecting survival in a larger group of women. The study was presented at the annual meeting of the American Society of Clinical Oncology.
The study included 15,438 women who were newly diagnosed with advanced breast cancer between 1988 and 2003. Information about their age, race, and other factors was obtained from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database.
To look at trends in survival over time, the women were divided into three groups based on when they were diagnosed: 1988 to 1993, 1994 to 1998, and 1999 to 2003. Overall, the chance of surviving for at least one year increased from 62.9% in the first time period to 64.4% in the second time period and 66.6% in the third period, the analysis showed.
When looked at by race, however, the picture changed. In the 1988 to 1993 time period, 63.2% of white women and 60.4% of black women survived one year. In the second time period, one-year survival rates were 64.9% and 58.1%, respectively. In the last time period, 67.6% and 58.8% of white and black women survived one year, respectively.
“The absolute difference in one-year survival rates between black and white women increased across the three time periods, from a 2.8% to a 6.8% to an 8.8% difference,” Giordano says.
Over the study period, the average time a woman lived from diagnosis also rose, from 20 to 21 to 25 months.
For white women, survival times improved from 20 months to 27 months over time. But among black women, survival times remained basically flat at 16 to 17 months.
“We’ve made huge strides in the treatment of advanced breast cancer, but as a group, black women are not benefiting from these improvements,” Giordano says. "Survival of non-Hispanic white women has improved, while survival of black women has remained unchanged,” she says.
Giordano says that the study was not designed to identify the reasons for the racial gap, but speculated that access to health care and utilization of screening programs may play a role. For example, research has shown that 20% of blacks vs. 11% of whites lack health insurance, she tells WebMD.
“But we need to do more research to find out what it causing the differences before we can fix the disparity,” Giordano says.
Archie Bleyer, MD, medical advisor in the Cancer Treatment Center at St. Charles Medical Center in Bend, Ore., says blacks may have an inherent distrust of the health care system due to inequitable treatment in the past. Bleyer tells WebMD that doctors have to put efforts into making all patients feel equal and comfortable.
“We don’t believe we treat patients differently, but our actions and words might not always convey that,” he says.
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