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Racial Disparities in Radiation Therapy
Reported December 16, 2009
(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 |
