(Ivanhoe Newswire) -- After a lumpectomy, black women are far less likely
than white women to receive radiation therapy, the standard of care for early
stage breast cancer.
Led by Grace Li Smith, M.D., Ph.D., postdoctoral fellow at The University of
Texas M. D. Anderson Cancer Center Department of Radiation Oncology, a team of
researchers reviewed the Medicare records of more than 37,000 patients diagnosed
with early stage breast cancer in 2003.
"Although there have been smaller studies of racial disparities in breast cancer
care, no prior research has examined the differences across the nation in the
rates of radiation therapy after lumpectomy between whites and blacks," Smith
was quoted as saying. "The national Medicare database, because it's so
comprehensive, allowed us to determine the extent to which racial disparities in
radiation therapy affected patients across the country."
Smith and colleagues used Medicare claims to examine the treatment history of
women aged 66 and older diagnosed in 2003 with early stage breast cancer. Of the
37,305 women who underwent a lumpectomy for their breast cancer, 34,024 were
white and 2,305 were black. Overall, 74 percent of the white women received
radiation therapy after their lumpectomies. Only 65 percent of the black breast
cancer patients received the same treatment.
"The use of radiation after lumpectomy is considered to be the standard of care
for women with invasive breast cancer, as clinical trials have demonstrated that
it both reduces the chance of recurrence and improves the chance of survival,"
senior author Thomas Buchholz, M.D., professor in the Department of Radiation
Oncology was quoted as saying. "While there are some breast cancer patients,
such as those over age 70, with significant co-morbidities for whom radiation
would not be appropriate, this discrepancy remained consistent when specifically
looking at patients under the age of 70."
Perhaps the most unexpected aspect of the study, said Smith, was the magnitude
of the disparity of those receiving follow-up radiation treatments in specific
areas of the country. In the Pacific West, 72 percent of whites vs. 55 percent
of blacks; East South Central, 72 percent of whites vs. 57 percent of blacks;
and in the Northeast, 70 percent of whites vs. 58 percent of blacks.
There were parts of the country -- the Mountain West (76 percent vs. 74 percent)
and the North Central Midwest (74 percent vs. 72 percent) -- where there was
virtually no discrepancy in radiation rates between whites and blacks.
"Until further research is conducted, we may only speculate about the underlying
reasons why black and white women are not receiving radiation at the same rate,”
said Smith. “We don't know if fewer black women are receiving radiation simply
because it is not offered to them, because they decline the treatment, or
perhaps because they are unable to complete a whole course of treatment due to
other health problems. These questions will be important subjects of future
study. As a medical community, we need to identify and eliminate any obstacle
prohibiting all women from receiving necessary care for their breast cancer."
SOURCE: Cancer, December 14, 2009
