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African american women higher breast cancer { December 7 2003 }

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Racial gap in breast cancer is noted
Study stirs debate over medical care

By Judy Peres
Tribune staff reporter

December 7, 2003

SAN ANTONIO -- African-American women taking part in clinical trials of breast cancer drugs do worse than other women, even when all other factors--including age, body mass, income, education and tumor size--are the same, according to new research.

The findings contradict the widely held belief--backed by some scientific research--that African-American women are more likely to die of their disease because they don't have access to good medical care, said the study leader, Dr. Kathy Albain of Loyola University Medical Center in west suburban Maywood.

All the women were enrolled in state-of-the-art clinical trials and received the same kind of treatment.

"It's clear other variables are involved," Albain said. Scientists need to look at biological and genetic factors that might predispose African-Americans to develop more aggressive strains of breast cancer or to respond differently to available treatments, she said.

The study of more than 6,500 women found that 68 percent of pre-menopausal black women were alive 10 years after their diagnosis, compared with 77 percent for all other ethnic groups. For post-menopausal women, median survival was 10.2 years, versus 13.5 years for all others.

Overall, black women were about 40 percent more likely to relapse or die than white women receiving the same treatment.

Albain presented her data at the annual San Antonio Breast Cancer Symposium, which ended Saturday.

More than 6,000 breast cancer experts from 82 countries attended the four-day meeting.

Socioeconomic factors often are blamed for the fact that black women tend to have larger tumors than white women. A long list of possible cultural factors also has been postulated, including shame, fear and distrust of doctors. But there are other differences besides tumor size.

Black women tend to be diagnosed at a younger age, to have tumors that are not hormone-sensitive, and to have cancer cells that are more abnormal--all factors linked to a worse prognosis.

Many experts now believe there must be biological differences that explain why black women get a more aggressive type of breast cancer. A 1992 study by a Nigerian researcher, Dr. F.N. Ihekwaba, found some similarities between the distribution of breast cancer in his country and in African-Americans. Compared with Caucasians, Nigerian women are diagnosed at earlier ages and with larger tumors.

But the so-called biological hypothesis draws emotionally charged reactions from others, who find the very idea of a "black" breast cancer racist.

Dr. Otis Brawley of Emory University, former director of the Office of Special Populations Research at the National Cancer Institute, insists aggressive tumors are more an issue of poverty than of ethnicity.

"The biggest reason for the disparity," Brawley said, "is not that the treatments don't work in black patients, it's that blacks don't get the treatments."

In many cases, he said, black women get less than the full dose of chemotherapy or radiation because they can't afford to take time off work, they can't get to the treatment facility, or they have other illnesses that make the cancer treatment too toxic.

"People are always looking for biological reasons--which allows us to accept the disparity and not look at the other reasons," Brawley said.

Indeed, numerous studies have shown that people in lower socioeconomic levels of all races have worse prognoses.

But Albain found that high-income black women did worse than affluent whites.

"It's true that poverty is more prevalent among African-Americans, and access to good care is worse," Albain said. "But even if you fixed all the other inequities, you still wouldn't solve the problem."

Albain's research collective, the Southwest Oncology Group, has begun looking for racial profiles in the gene signatures of tumors stored in its tissue bank and for racial differences in specific genes that metabolize drugs.

Vernal Branch, a black breast-cancer patients' advocate, welcomed the study, saying there may well be biological differences in addition to social and cultural ones.

"I know a lot of women who would be pleased to take part in research to explore those [biological] differences," said Branch. "We're tired of African-American women dying of this disease."

Breast cancer is not the only disease where blacks fare worse than whites. Blacks also have higher death rates from heart disease and strokes.

In the area of cancer, however, there are no racial disparities in common malignancies such as lung cancer, colon cancer, lymphoma or leukemia, Albain said--just breast, ovarian and prostate cancers.

"Something is going on in tumors with a hormonal bent," she said.

There is considerable evidence that minorities often get second-rate health care in the U.S. Last year, the prestigious Institute of Medicine of the National Academies issued a wide-ranging report that found significant variation in the rates of medical procedures by race, even when insurance status, income, age and severity of disease were comparable.

The report indicated that racial and ethnic minorities were less likely to get even routine medical procedures and experienced a lower quality of health services in general.

Copyright 2003, Chicago Tribune

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