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 Researchers focused on a type of breast cancer that affects roughly
one in four patients with these malignancies. The tumor cells have
unusually high amounts of what's known as HER2 receptors, a protein
on the surface of cells that can help tumors grow and divide faster.
Women with these malignancies have so-called HER2-positive tumors.
They can be treated with a targeted therapy called trastuzumab (Herceptin)
that can slow or stop the spread of breast cancer by attaching to
the HER2 receptors and blocking signals that trigger tumor growth.
When researchers examined data from Medicare, the U.S. health
program for people over age 65, they found just 40 percent of black
women with HER2-positive tumors received trastuzumab, compared with
50 percent of white women.
"A very substantial racial disparity exists," said study leader Dr.
Katherine Reeder-Hayers of the University of North Carolina Chapel
Hill Lineberger Comprehensive Cancer Center.
"Although we don't know for sure why this is happening, the fact
that the treatment is relatively new, expensive, and lengthy may all
be contributing," Reeder-Hayes added by email.
Reeder-Hayes and colleagues looked data on about 1,400 women
diagnosed with HER2-positive breast cancer in 2010 and 2011 and
examined how many of them received trastuzumab in the year after
their diagnosis.
After adjusting for tumor characteristics, poverty and patients'
other medical problems, black women were 25 percent less likely to
get trastuzumab than white women, researchers report in the Journal
of Clinical Oncology.
It's possible that some of the women didn't receive trastuzumab
because of the risk of heart damage and other side effects that come
with the drug, said Erica Warner of Massachusetts General Hospital.
"I think concerns about toxicity, particularly cardiotoxicity, in
women (who) may have other chronic diseases and limited life
expectancy gives some clinicians pause," Warner, who wasn't involved
in the study, said by email.
Because many women over age 70 don't receive chemotherapy or
targeted treatments like trastuzumab, the racial disparities found
in the study might not look the same among younger women, noted Dr.
Richard Bleicher of Fox Chase Cancer Center in Philadelphia.
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"At the extremes of older age, patients may die of other causes,"
Bleicher, who wasn't involved in the study, said by email. "That
having been said, if the patient is appropriate for it, it should be
offered."
One limitation of the study is that Medicare data can't provide a
full picture of medical conditions that might influence whether
doctors give women trastuzumab, the authors note. In particular,
they lacked data on heart conditions that might make this treatment
too risky.
"There is no way to fully understand what was recommended to
patients, whether they refused treatment, or whether there was some
other barrier," said Dr. Rachel Freedman of the Dana-Farber Cancer
Institute.
Still, many women in the study were probably under-treated, and the
racial disparities in trastuzumab therapy are consistent with
earlier research, Freedman, who wasn't involved in the study, added
by email.
"The patterns observed for trastuzumab are not that different from
disparities observed for most health care," Roshan Bastani, director
of cancer disparities research at the University of California, Los
Angeles Jonsson Comprehensive Cancer Center, said by email.
"Those less likely to receive optimal care tend to be poor, ethnic
minority and the elderly," Bastani, who wasn't involved in the
study, said by email. "The consequence of this is that these groups
are deprived the opportunity to benefit from scientific advances in
care and are at increased risk for poorer outcomes."
SOURCE: http://bit.ly/1YydHma Journal of Clinical Oncology, online
April 7, 2016.
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