African Americans diagnosed with breast, ovarian, and prostate cancer have overall worse prognoses than people of other races with the same cancer type. Doctors have wondered whether these differences are the result of differences in access to medical care, and in the quality and consistency of medical care received, by African Americans. The research reviewed here found that in the case of these three cancers, genetic factors -- not differences in quality of care or access to that care -- account for the worse prognoses.
The researchers reviewed the medical care and outcomes of nearly 20,000 adults diagnosed with a variety of cancer types. All of the adults received very consistent care because they were participating in carefully monitored clinical trials. Nearly 12% of these people were African Americans. The researchers found that even though care was consistent among all patients followed, regardless of race, the overall prognosis for three gender-related cancers -- breast, ovarian, and prostate cancers -- was worse among African Americans compared to that of other racial groups. For cancers that are not gender-related, the outcomes were the same.
Compared to women of other races, African American women are:
The research reviewed here confirms findings of other research, which found that these differences in breast cancer are mostly due to genetic differences between African American women and women of other racial types. Still, other research shows that when care is not consistently controlled and monitored as it was for the patients followed in the study reviewed here, African Americans diagnosed with a variety of cancer types that are not gender-related (for example, colon or lung cancer) have worse prognoses that people of other racial types. This suggests that the poorer prognoses of African Americans diagnosed with cancer are, at least in part, related to differences in medical care access and quality.
EVERY woman with breast cancer -- no matter her age, height, weight, ethnicity, or medical history -- is unique. And the same is true of every breast cancer. The challenge is to better understand the differences in breast cancer biology. Researchers hope to develop tests that can give us a fuller, more complete picture of a cancer's genetic makeup. Then treatments can be prescribed that are personalized for each cancer.
Until that time, screening is a good place to start eliminating the differences. Breast cancer that is diagnosed early is typically easier to treat and offers the best survival chances.
Regular screening for breast cancer, including breast self-exam and mammograms, is important for everyone. When you have a mammogram, make sure your doctor tells you about the results. If you don't hear something, call the office. If you're not sure what the results mean, ask your doctor right away. If cost or scheduling problems are making it hard for you to schedule a mammogram or a follow-up visit with your doctor, ask for help. It's YOUR health and YOUR future and you deserve the best care possible.
SAN FRANCISCO, July 9 (MedPage Today) -- African-Americans are more likely to die from breast, prostate, and ovarian cancers than other races -- even when they get identical medical care and after controlling for other socioeconomic factors, researchers found.
But no other major cancers produced the persistent racial disparity with equal treatment, and after adjustment for tumor prognostic factors, demographics, and socioeconomics, Kathy S. Albain, MD, of Loyola University Chicago in Maywood, Ill., and colleagues reported.
Their analysis of Southwest Oncology Group trials suggested that access to care, later stage diagnosis, and poverty -- widely blamed for cancer disparities -- don't tell the whole story, they wrote online in the Journal of the National Cancer Institute.
For the sex-specific cancers, biologic and genetic factors are likely to play a role, they said.
In an accompanying editorial, Otis W. Brawley, MD, chief medical officer of the American Cancer Society, emphasized that race is not a scientific categorization and is rejected by many anthropologists.
Rather, it is "a surrogate for area of geographic origin, socioeconomic status, and culture, all of which can have correlations with disease risk," he noted.
Dr. Brawley added, "Perhaps advances in our understanding of biology will lead us away from concerns about race and we will better define high-risk populations using pathological markers of disease."
Dr. Albain's group pooled findings from 35 Southwest Oncology Group randomized, phase III trials in which a total of 19,457 adult cancer patients (11.9% African American) got uniform treatment by protocol and met similar entry criteria, including disease stage.
After adjustment for each cancer's prognostic factors, such as tumor size, the researchers found no significant association between African-American race and overall survival in the following:
"Good care in good hands gives the same outcome for all patients for the most part," Dr. Albain said.
But compared with all other racial and ethnic groups combined, African-Americans had significantly poorer adjusted overall survival for sex-specific cancers. The 20-year survival estimates were:
Adding income and education to these analyses did not substantially impact the associations of race with overall survival.
Nor did comparing cause-specific mortality or comparing African-American patients to whites with other groups excluded.
Notably, an analysis of breast cancer by histology showed elevated overall mortality after full adjustment in African-Americans, compared with other groups for both hormone receptor-positive and hormone receptor-negative tumors.
This suggested that "the triple-negative biology theory cannot be the sole explanation for the difference in breast cancer outcomes by race," the researchers said.
They cautioned that the studies did not control how patients were diagnosed, making it possible that non-African American patients were more likely to be screen detected, resulting in lead-time bias.
But cause-specific mortality analysis showed this did not explain the findings, they noted.
Since population-based studies have shown significant racial disparities in survival of cancers beyond just breast, ovarian, and prostate cancers, Dr. Brawley said the findings provide further evidence that real-world care is not equal.
"Blacks are less likely to have their disease detected early, and when it is detected, they are less likely to receive adequate treatment," he concluded.
The individual studies in the analysis were funded by the National Institutes of Health. The researchers reported no conflicts of interest.
Dr. Brawley provided no information on conflicts of interest.
Primary source: Journal of the National Cancer Institute Source reference: Albain KS, et al "Racial Disparities in Cancer Survival Among Randomized Clinical Trials Patients of the Southwest Oncology Group" J Natl Cancer Inst 2009; 101: 984-992. Additional source: Journal of the National Cancer InstituteSource reference: Brawley O "Is Race Really a Negative Prognostic Factor for Cancer?" J Natl Cancer Inst 2009, 101: 970-971.
Breastcancer.org 7 East Lancaster Avenue, 3rd Floor Ardmore, PA 19003
Learn more about our commitment to your privacy
© 2009 Breastcancer.org - All rights reserved.
Breastcancer.org is a non-profit organization dedicated to providing information and community to those touched by this disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information.
