Racial Disparities Affect Breast Cancer Treatment

By all accounts, breast cancer survivor Yvonne Durham was lucky.

"It was the Friday before Mother's Day of 1992," she said. "I had had a biopsy of a lump in my left breast. And a man walked into the room and told me I had breast cancer."

"I was shocked. I was just totally shocked."

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After her diagnosis, Durham began a long road of treatment that included surgery, radiation therapy and hormone therapy with the drug Tamoxifen.

The treatment may be a major reason she is alive today. But a new study suggests that black women like Durham may be three times less likely to receive chemotherapy and five times less likely to receive Tamoxifen than their white counterparts.

"I had an excellent doctor, and in my heart I don't want to think that black women get different treatment," said Durham, who added that she was pleased with the level of care she received. "But sometimes I've noticed that doctors tell their white patients more than they tell us."

And when it comes to breast cancer, knowledge is key.

"For example, I had a white girlfriend with breast cancer who asked me if I was Her2 receptor positive. I didn't know what she was talking about," Durham said.

"My friend was no more educated than I was. But these receptors were explained to her. Staging was explained to her. I knew I had a good doctor, but I didn't know anything about these things."

White Women More Likely to Get Chemo

Whether because of breakdowns in doctor-patient communication or some other factor, disparities between the treatment of black women and white women with breast cancer exist, according a new study published today.

Researchers at the University of Michigan and Wayne State University found that among women with breast cancer that had spread to lymph nodes, white women were three times as likely to receive adjuvant chemotherapy and almost five times as likely to receive Tamoxifen, a common hormonal drug for breast cancer.

The study examined medical records from 651 women diagnosed with breast cancer at a major university hospital and cancer center in Detroit from 1990 to 1996. Of the women, 242 were white and 388 were black.

Previous studies had also shown differences in treatment rates between blacks and whites, but discerning the reasons for the differences was often difficult.

Blacks, for example, have been found to have a higher percentage of breast cancers that are "estrogen receptor negative," meaning they will not respond well to traditional hormone treatments such as Tamoxifen. Lower socioeconomic status, later stage at the time of diagnosis and several other factors had also been cited in the past as a possible reason for the disparities.

The researchers looked at women who had both "local stage" — cancers confined to the breast — as well as "regional stage" — cancers that had either spread to lymph nodes or physically extended outside the breast.

They then catalogued the types of treatment used. This included types of initial treatment such as mastectomy or breast-conserving surgery (such as lumpectomy) plus radiation, as well as "adjuvant," or supplemental, treatments like chemotherapy and hormone therapy with the drug Tamoxifen.

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