"A challenge to society"

Breast-cancer treatments, outcomes vary widely among women of different races, ethnicities

Important disparities in breast-cancer diagnosis, treatment and survival among American women of various racial and ethnic backgrounds are documented in a new Fred Hutchinson study.

These findings by Drs. Christopher Li, Kathleen Malone and Janet Daling are based on the largest, most comprehensive study of its kind to evaluate the relationship between race/ethnicity and breast-cancer stage, treatment and survival.

The study evaluated data from nearly 125,000 women representing all major racial/ethnic populations and subpopulations in the United States, the majority of whom have been tracked by national cancer registries only since the late 1980s.

"Numerous studies have evaluated the relationship between race and ethnicity and breast-cancer treatments and outcomes, but most have crudely divided the data into broad heterogeneous categories, such as Asians/Pacific Islanders and non-Hispanic whites," Li said.

"This study, in contrast, evaluated several subgroups of these populations and found important differences among them.

"There is reason to believe that there would be differences in breast-cancer outcomes based on diverse cultural practices, dietary habits and, possibly, genetics, but socioeconomic factors are likely to play the most important role."

Among Asian/Pacific Islanders and Hispanic whites, Li and colleagues uncovered significant differences in stage at diagnosis, treatment and outcome among women in various racial/ethnic subcategories, including Japanese, Filipino, Indian/Pakistani, Mexican and Puerto Rican. Japanese women fared best overall.

The study also confirmed and extended previous findings that many breast-cancer patients of minority background have an increased likelihood of being diagnosed at later stages of disease, receiving inadequate treatment or dying of their disease.

"One of the most disturbing trends identified by our research is that we have known since the 1970s that certain racial/ethnic groups, such as African-Americans, have poorer breast-cancer outcomes," Li said. "Even though we've recognized this for some time, the trend persists. Despite having several decades to improve this situation, it remains an important, big problem."

While underlying biological differences among ethnic groups could be a contributor, Li and colleagues suspect that lack of access to health care is the largest factor behind the increased mortality rates for African Americans, Native Americans and Hispanics.

"In our analysis, we adjusted for stage of disease, hormone-receptor status of the tumors and the types of treatment the women received," he said. "Even after adjusting for these factors, these groups of women were still more likely to die of breast cancer.

"This means that disparities in outcomes are likely due to other issues, such as access to care and socioeconomic status."

-Kristen Woodward

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