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 Compared to black women, non-Hispanic white women were more likely
to be diagnosed when their breast cancer was at an early stage, the
research showed. And black women had a higher risk of dying from
their breast cancer, compared to white women.
The study team thinks these disparities are due to "a combination of
biology and other factors that warrant further investigation to
improve survival of all women,” said Dr. Ophira Ginsburg, one of the
study’s authors from the Women’s College Hospital in Toronto.
The researchers write in JAMA that women diagnosed with early
invasive breast cancer – known as stage I - have generally good
outlooks, but there are racial differences in a number of factors
that affect how well they do.
For the new study, the researchers used a U.S. database to analyze
nearly 450,000 invasive breast cancers diagnosed between 2004 and
2011.
Overall, about 51 percent of white non-Hispanic women in the sample
were diagnosed with early-stage cancers, which are thought to have
the best prognosis if properly treated. Only about 37 percent of
black women were diagnosed with early cancer, making them less
likely to have that good prognosis.
The researchers also found that about 6 percent of black women were
predicted to die within seven years after their breast cancer
diagnosis, compared to about 3 percent of white women.
Black women were also more likely to die from small tumors, compared
to white women.
Differences still remained after the researchers excluded women with
a more aggressive form of breast cancer known as triple-negative,
which is known to be more common among black women.
After accounting for various factors that are known to affect breast
cancer outcomes - including income - the differences in outcomes
persisted, which suggests to the researchers that other biological
reasons - such as the aggressiveness of the tumors, for example -
were behind the disparities.
They don’t believe a lack of screening among black women leads to a
later diagnosis of cancer, because the relationship is even seen in
age groups that don’t normally receive mammograms.
Ginsburg said that other characteristics that could not be
completely accounted for within the study may influence the results,
such as access to care.
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“We do know that breast cancers in African American women do tend to
be more aggressive than breast cancer in white women,” said Dr.
Nancy Keating, a cancer researcher at Brigham and Women’s Hospital
in Boston who was not involved with the new study. “This - as well
as other studies - supports this.”
However, it’s still a question of how much of the differences
between diagnosis and care can be attributed to biology, said
Keating, who is also a professor of healthcare policy at Harvard
Medical School.
Regardless of where the blame for more aggressive cancers lies, Dr.
Funmi Olopade told Reuters Health that it’s time women with breast
cancer be treated as individuals.
“I think we’re in an era of precision medicine now,” said Olopade,
who co-authored an editorial accompanying the new study. “What’s
really been rewarding about the advances in breast cancer research
is that we’re beginning to have the granular data to treat each
patient as a unique individual and to look at their tumors as a
unique tumor that we need to develop a strategy to treat.”
Historically the U.S. focused on getting everyone screened,” said
Olopade, a breast cancer expert at the University of Chicago.
“The one size doesn’t fit all,” she said. “The conversation we
should be having is ‘we have breast cancer, but what type do I
have?’”
SOURCES: http://bit.ly/1wVUyw4 and http://bit.ly/1wVUCMl JAMA,
online January 13, 2015.
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