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Thursday, September 1, 2011

Black/White Breast Cancer Disparities: The Latest Chapter

Knowing is not enough; we must apply.
Willing is not enough; we must do. 

--Goethe

Breast Cancer is a devastating disease. Unfortunately, this is a fact that I know all too well. Last weekend, a loved one of mine was dealt some horrible news: On the eve of her mother’s five-year anniversary of survival, her family learned that their mother’s cancer had returned and moved from Stage 2 to Stage 4—it is now in her bones.

Too many women face the devastating reality of a cancer diagnosis every day—one every three minutes. In my life alone, this tally has included my mother’s best friend, my great aunt, and my classmate’s sister. These women fight with all their strength to survive until the next day, just to wake up and start again.

But the truth is—many women don’t win the fight. What’s more, breast cancer is more lethal for black women, for reasons no one seems to fully understand. The Federal Office of Minority Health reports that while black women are 10% less likely than white women to be diagnosed with breast cancer, they are 1.5 times more likely to die from it. Similarly, black women’s five-year relative survival rate was 10% to 15% lower than white women’s, according to the American Cancer Society: The average white woman with a breast cancer diagnosis has a 90% chance of living five years or more, whereas a black woman only has a 78% chance.

Breast cancer disparities between black and white women have been documented for decades. Often, they have been attributed to issues of access, quality of care, and cultural differences. But finding the real root of these disparities has evaded researchers for years. Recently, however, the National Cancer Institute took a huge step toward seeking the real cause. Their groundbreaking study attempted to cut the access variable out of the picture: It documented, for one of the first times ever, differences between black and white patients with the same insurance and in the same system of care. Previous studies often speculated that disparities are a product of barriers to access to care for the black population, but this study shows that even when access to care is controlled for, disparities persist.

This study found that black women were less likely to receive aggressive treatment for late-stage breast cancer and were more likely to die from it. Black women with localized breast cancer received the same treatment as white women. However, if the cancer had progressed and spread outside of the breast itself, black patients were 60% less likely to receive chemotherapy and 50% less likely to receive hormonal therapy than white patients with a similar stage of cancer.

As the researchers point out, these findings lead to more questions about the cause of these disparities. For example, in a recently published report on the National Cancer Institute study, Reuters Health group speculated that higher rates of poverty and illness and/or cultural differences might be the cause. But the study controlled for health status and cancer stage, and given that the women in the study were either active duty military or a dependant of someone in the military, it is unlikely that poverty rates had much of an impact on the study’s results.

So that leaves cultural differences, which unfortunately, the research community and the general public often latch on to as an explanation of health disparities. While some cultural aspects, such as attitudes toward doctors or one’s spiritual beliefs, definitely can and do play a role in how all women—including black women—make decisions about their care, “cultural differences” should not become a magic wand to explain disparities away. Accepting this explanation can lead people to think that because black women die more, they must not value their health as much as white women: They don’t take the right preventive steps, they wait too long to see a doctor, they don’t choose the right treatments. This “blame the victim” approach only leads to one place—the status quo. And, it doesn’t help solve the problem.

The cultural differences magic wand only makes disparities disappear from the research agendas, not from the lives of black women who are fighting a deadly foe. Research must investigate the broad range of issues that could be influencing outcomes—from employment and economic factors to possible differences in doctor-patient communication, and everything in between. And if cultural differences are found to truly be the reason behind cancer treatment disparities, then we need further research on how to mitigate and prevent their negative effects on black women’s health.

As breast cancer research gets more sophisticated, it’s incredibly important that it equally benefit all women, or we will just create more inequality.