Insurance, Income Don't Explain 'Race Gap' in Breast
TUESDAY, Oct. 12 (HealthDay News) -- The so-called racial gap in
breast cancer care has long been known by researchers, with black
and Hispanic women less likely to get recommended breast cancer
treatments than white patients.
"Less well known is what the issue is -- is it race itself or something else contributing?" said Dr. Rachel Freedman, a medical oncologist at Dana Farber Cancer Institute in Boston, and an instructor in medicine at Harvard Medical School.
Her team's new study suggests that financial factors such as
economic and social class or access to insurance alone can't
explain the "gap": Even after accounting for those differences,
racial disparities in breast cancer care still showed up.
The study, published online Oct. 11 in the journal
Cancer, "was unique because it included adult women of all ages, and included [those with] insurance," Freedman said.
Freedman evaluated information on more than 662,000 white, black
and Hispanic women diagnosed with invasive breast cancer from 1998
to 2005. She used data from the U.S. National Cancer Data Base, a
registry that collects information on patients' treatments,
outcomes, insurance and socioeconomic status.
In the database, 86 percent of the women were white, 10 percent
black, and 4 percent Hispanic.
When they evaluated whether women got the correct treatments and
testing, the team found no differences by race/ethnicity for
hormone receptor testing (evaluating whether a cancer is
estrogen-receptor positive or negative, which could help guide
But they did find differences in other interventions. For
example, black women had lower odds of getting recommended
treatments -- interventions such as mastectomy or breast-conserving
therapy, chemotherapy and hormone therapy (such as aromatase
inhibitor drugs to reduce recurrence risk), Freedman said. And
Hispanic women were less likely than white women to get hormonal
Freedman found black women 9 percent less likely than white
women to get mastectomy, breast-conserving surgery or other
treatments, 10 percent less likely to get hormonal therapy and 13
percent less likely to get chemotherapy.
Importantly, these disparities persisted even after the
researchers accounted for insurance coverage and socioeconomic
status. "In this study, even with those with the same insurance,
there were race gaps," Freedman said.
"Further investigation is needed," she said, "to figure out which [other] factors are meaningful."
Freedman said the study does have limitations, including her
finding of relatively modest absolute differences in the care
different types of patients received. Even so, because breast
cancer is so often diagnosed, these small discrepancies would end
up affecting large numbers of women, she said.
While the database was large, the information was not always
complete. Information was missing on many women. For instance, more
than 46,000 women were excluded from the chemotherapy analysis,
because data was missing.
One expert agreed that a gap in care linked to race does seem to
Despite the study's limitations, "it does look like there still
are racial differences, but tempered somewhat by insurance and
socioeconomic status," said Dr. Nina Bickell, associate professor
of healthy policy and medicine, Mount Sinai School of Medicine in
New York City.
But for women of any race diagnosed with breast cancer, the
message is the same, said Bickell. "I would tell anybody they
should be getting information, and there's lots of excellent
information available to those with breast cancer."
"Get it from credible sources," she said, such as the American Cancer Society.
She also recommends that women diagnosed with breast cancer
write a list of questions before they go in for a doctor visit,
take a friend or family member with them to help them understand
options, and consider taking a tape recorder so information can be
To find out more about race-linked discrepancies in cancer care,
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