African American women diagnosed with breast cancer generally have a worse prognosis compared to women of other races diagnosed with breast cancer. Doctors wanted to know if the difference could be due to:
by African Americans. Both access to care and quality and consistency of care can be affected by whether or not a person has adequate health insurance.
The study reviewed here looked at 574 African American and non-Hispanic white women, 84% of whom had inadequate or no health insurance. The African American women in the study were:
The results suggest that having no or inadequate health insurance makes a bigger difference in breast cancer prognosis for African American women compared to white women.
Besides having no or inadequate insurance, most of the women in the study were poor. All of them received breast cancer treatment at a public hospital that cares for people whether or not they have insurance. Researchers call these hospitals "public safety net" hospitals. So the researchers believed that the quality and consistency of the women's care was the same regardless of race, economic status, or type of health insurance.
Genetic factors affect the aggressiveness of breast cancer and aggressiveness affects prognosis. Genetic factors are why breast cancers diagnosed in African American women tend to be more aggressive than breast cancers diagnosed in white women and have a worse prognosis. In this study, the researchers used a complicated mathematical model to account for the genetic differences between breast cancers in African American women and breast cancers in white women. Accounting for the genetic differences showed that breast cancer prognosis was similar among white women and African American women.
Prognosis also is affected by a breast cancer's stage at diagnosis. Regular breast cancer screening helps make sure that any cancer is diagnosed at an early, more treatable stage. Lack of breast cancer screening can mean a delay in breast cancer diagnosis and a worse prognosis. This study found equally poor breast cancer screening among white and African American women. Still, the breast cancers diagnosed in the African American women tended to be more advanced at diagnosis compared to cancers diagnosed in white women.
The results suggest that having inadequate or no health insurance may affect breast cancer prognosis more in African American women than in white women. This is because inadequate breast cancer screening causes delayed diagnosis of breast cancers that are more aggressive.
ALL women -- no matter their age, ethnicity, economic status, or insurance status -- deserve the best care and the best prognosis possible if breast cancer develops. Genetic differences can't be eliminated, but other differences that affect prognosis -- screening, access to care, and quality and consistency of care -- should be eliminated.
Screening is a good place to start. Genetic differences aside, breast cancer that is diagnosed early is typically easier to treat and offers the best survival chances. Regular screening for breast cancer, including annual mammograms and breast exams by a medical professional, is important for everyone. Paying for healthcare can be difficult, especially if you have limited income and no or inadequate health insurance or are covered only by Medicare. But if you're older than 40, skipping regular mammograms is NOT an option. Stick with the screening plan you and your doctor decide is best for you. If scheduling problems or cost concerns are stopping you from getting a mammogram, talk to your doctor, a hospital social worker, or a staff member at a mammogram center. Ask about free mammogram programs and healthcare services in your area. It's YOUR health and YOUR future and you deserve the best care possible.
(MedPage Today) -- Going uninsured or underinsured may have a bigger impact on breast cancer outcomes for black women, researchers found.
In a population in which 84% of women had inadequate insurance, African Americans carried a 64% higher risk of dying from breast cancer than did non-Hispanic whites (26.0% versus 17.5%, P=0.028).
Age at diagnosis, clinical stage, and hormone receptor status appeared to be playing a role; adjustment for these factors eliminated the significance of race, Ian K. Komenaka, MD, of Wishard Memorial Hospital in Indianapolis, and colleagues reported online in the Journal of the National Cancer Institute.
Because prior studies looking at racial disparities in breast cancer typically grouped together patients from a range of areas and treating centers and never looked at an underinsured population, Komenaka's group retrospectively reviewed medical records for 574 breast cancer patients treated at one of the nation's largest public safety net hospitals.
In this "equal access" cohort, African American and non-Hispanic white women were equally poor, with more than 75% in both groups reporting a household income under $18,000 per year.
White patients were more likely than African American patients to be covered by commercial insurance (19% versus 14%) but were also more likely to have no insurance (13% versus 8%).
Notably, surgical care and adjuvant therapy were similar between racial groups, unlike in prior studies that had suggested African American women were less likely to get breast-conserving surgery and adjuvant therapy.
Among the outcomes, non-Hispanic white patients held the advantage for seven-year overall survival compared with African American patients (75.4% versus 69.2%, P=0.048).
The association with race remained significant, with a hazard ratio of 1.39 for death in a multivariable analysis that included clinical stage and age at diagnosis (P=0.05).
But race lost significance after additionally controlling for estrogen receptor status (HR for death 1.37, P=0.08).
The higher death rate in African American patients appeared to be almost entirely accounted for by a disproportionate breast cancer death rate (18.6% versus 12.2%, P=0.058).
But in a fully adjusted model, breast cancer-specific mortality no longer differed significantly for African American versus non-Hispanic white women (HR 1.26, 95% confidence interval 0.79 to 2.00).
The researchers noted that despite having similar levels of access to medical care and equally low levels of screening mammography in the two years prior to breast cancer diagnosis, African American women presented with a more advanced clinical stage of breast cancer.
Differential delays in getting treatment couldn't explain the findings either, they said.
The researchers cautioned that their study was limited by the retrospective data collection, which left them without information on chemotherapy dose delays or reductions, deviations from radiation schedules, and compliance with hormonal therapy.
Its single-center scope also gave a relatively small sample size, they noted.
The researchers reported no external funding for the study. No conflicts of interest were reported.
Primary source: Journal of the National Cancer Institute Source reference: Komenaka IK, et al "Race and ethnicity and breast cancer outcomes in an underinsured population" J Natl Cancer Inst 2010; 102: 1–10.
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