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Women's
Health (1)
Racial Disparity Shown in Breast Cancer
Treatment
By Amanda Gardner
HealthScoutNews Reporter
MONDAY, May 19, 2004 (HealthScoutNews) --
Differences in how black women are treated for breast cancer (news
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web sites) may explain why they have lower survival rates than white
women even when the cancer is discovered at the same stage.
A study in the June 1 issue of Cancer found significantly lower
stage-specific survival rates for black women under the age of 50 even
when the type and stage of the breast cancer were identical. On the other
hand, there were no significant differences in women over the age of 65,
suggesting the universal availability of Medicare might iron out earlier
disparities.
"If you have a high percentage of people covered with Medicare, the
differences that you see in the younger age groups need to be thought of
not only in the parameters of biology and aggressiveness, but also in the
parameters of the health-care system," says study author Kenneth C. Chu,
program director of the Center to Reduce Cancer Health Disparities at the
National Cancer Institute (news
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web sites). "We're trying to open up that door so that discussion can
begin."
The issue of racial disparities in health care has been a subject of
increased interest and scrutiny, and the picture emerging is an incredibly
complex one.
According to Barbara Krimgold, director of the health disparities
project at the Center for the Advancement of Health, there appear to be
four broad reasons why black women have higher mortality rates from breast
cancer, even though white women have a higher incidence. Those areas are
socioeconomic status, racism, access to insurance and health care and
treatment.
Previous studies have shown black women are less likely to get
mammograms and are therefore diagnosed later than white women. They are
also less likely to receive the same treatments.
"As the Institute of Medicine (news
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web sites)
reported, even where African-Americans have equal incomes
or equal insurance, the treatment is different and the outcomes are
different. So you frequently get less aggressive treatment, and it's
sometimes less awareness on the part of the patients and probably
unconscious discrimination in most cases on the part of providers, who
don't seem to act as quickly or as aggressively in treating their black
patients," Krimgold says.
Clinical trials, however, have shown that when black and white women
receive equal treatment for their particular type of breast cancer, they
have similar survival rates.
Using breast cancer data from the National Cancer Institute's
Surveillance, Epidemiology and End Results (SEER) Program, Chu and his
colleagues compared survival rates in black and white women at specific
stages of breast cancer and according to ER status. In other words, a
white woman with stage 3 ER-positive breast cancer would be compared only
to a black woman with stage 3 ER-positive breast cancer.
"The ER status is related to the types of treatment you have," Chu
explains. ""What I tried to do was remove the fact that black women
present at a later stage from their actual survival."
In general, black women had lower six-year survival rates for each
stage of breast cancer. The differences were more pronounced in younger
groups, however. Black women under the age of 50 with ER-positive cancers,
for instance, had significantly lower six-year survival rates. In the
over-65 group, there were no real differences.
Most other researchers have used the age of 50 as a cut-off point, to
coincide roughly with the beginning of menopause. "When you look at that
break, you'll see differences in both age groups," Chu says. "We looked at
the older age group because we were interested in knowing not the biology,
but whether or not Medicare may in fact have some potential impact."
This study suggests an association, but it doesn't prove a
cause-and-effect link. And the association has been noted before. "When we
compare the U.S. to other countries, we see the U.S. hovering around 20th
among all industrialized nations for almost all health status indicators:
infant mortality, life expectancy and potential years of life lost
prematurely," Krimgold says. "But once people in the U.S. make it to age
65, the U.S. rises near the top of the health indicator tables. With
universal health care and income support through Medicare and Social
Security (news
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web sites), elderly people in the U.S. have better prospects for
health and life expectancy compared with their counterparts in other
countries than do younger Americans."
But the prospects of middle-age black women shown in this study were
troubling to Dr. Alfred R. Ashford, a professor of clinical medicine at
Columbia University College of Physicians and Surgeons and director of the
department of medicine at Harlem Hospital, both in New York City.
"I think that's very tragic in our society that all the pieces of a
modern treatment package are not always there for women of various
backgrounds but perhaps, in particular, the poor and ethnic minority
groups. It has to be corrected," Ashford says. "We call this an
access-to-care problem. We have public safety net hospitals, which usually
can provide this care."
People are probably not accessing this safety net because they are not
aware they exist, adds Ashford, who is also director of the cancer center
for Lincoln, Metropolitan and Harlem hospitals, all of which are part of
the New York City public hospital network.
At first she did not like the idea of
breast
reconstruction
By Carl Gilbert, M.D.
On the verge of losing her breast to
cancer, Claudia, 36, a model, did not want to hear about having a new
breast. As a matter of fact, the first surgeon she went to see did not
mention breast reconstruction to her at all...
When Claudia came to see me for a
second surgical opinion, she was in denial. After her examination, and
after reviewing her case, I confirmed the diagnosis of breast cancer, and
the need for her to have a mastectomy since she was not a candidate for
breast salvage operation. I discussed all aspects of treatment with her,
including breast reconstruction.
She started to cry, showing the mask of
fear on her youngish, beautiful ebony face. I let her sit for a while,
respecting her deep thoughts and feelings. She suddenly stood up as though
she wanted to leave the office.
I came to realize she was strongly
against the breast reconstruction even when she had accepted the fact she
had breast cancer and would have to lose her breast. Her arguments: no
foreign body in her body; not willing to have life long side-effects from
those silicone implants as she had heard in the news; not ready to have a
“crooked” posture like those women who had had belly muscle transplant
(TRAM procedure). In short, she had all the misconceived, prejudged ideas
about breast reconstruction.
I did my best to convince her favorably
to the contrary. I even told her that that breast reconstruction in some
studies has been shown to improve survival in breast cancer, almost the
same way as does good psychological support.
After a
while, Claudia’s face started to brighten, her fear seemed to have faded
away. The shadow of a smile appeared on her face when she told me as she
was leaving the office: “ See you Doc, in surgery.”
Click here for more breast cancer treatment
Other
Related Topic:
Breast Reconstruction Less Likely for Black Women
Breast milk is considered babies'
perfect food. Yet, despite a decade of encouraging more American mothers
to breast-feed their infants, not enough do. And among black women,
breast-feeding is ``alarmingly low,'' according to a government report.
Only 29 percent of all moms, and 19
percent of black mothers, breast-feed until their babies are 6 months old
- a crucial time period, says the report of Surgeon General David Satcher
. The report calls for a cultural shift in how the nation regards
breast-feeding - with policies to ensure that parents are told routinely
why it's so healthy, that hospitals improve teaching of mothers in how to
do it, and that workplaces make breast-feeding easier for employees.
Black women in particular too often get
little encouragement, especially because their own mothers likely used
infant formula. Support from the babies' fathers must be also sought,
according to the report.
``The culture of breast-feeding has
been lost, especially in the low-income African-American community,'' said
Dr. Yvonne Bronner of
The government hopes thanks to
education by 2010 at least half of mothers will breast-feed exclusively
until age 6 months, when solid foods are added, and at least 25 percent
will continue breast-feeding until the baby's first birthday.
Why is breast-feeding so
much better than formula? Breast-fed babies suffer fewer illnesses such as
diarrhea, earache, pneumonia and other infections. Studies suggest
breast-fed babies also may be less likely to develop asthma, diabetes or
childhood cancer. Their brains seem to develop faster, their immune
systems respond better to vaccines and they are less likely to become fat
later in childhood. (Source: AP)
Related Links About Breast Feeding:
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