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
