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Study Finds Non-Whites More Likely to be Diagnosed with Advanced Breast Cancer (dateline May 28, 2003)

Non-white American women are more likely to be diagnosed with advanced breast cancer, according to a new study. Furthermore, there are differences in the quality of breast cancer treatment and the chances of survival based on race and ethnicity. The researchers say improvements could be made by making sure that women of socioeconomic statuses receive proper breast cancer screening and treatment.

The study included a total of 124,934 women diagnosed with breast cancer between January 1, 1992 and December 31, 1998. The breakdown by ethnicity was as follows: 97,999 non-Hispanic whites; 10,560 African-Americans; 322 American Indians; 8,834 Asians and Pacific Islanders; and 7,219 Hispanic whites. Christopher I. Li, MD, MPH and colleagues from the Fred Hutchinson Cancer Research Center in Seattle, Washington analyzed the women’s medical records to evaluate the relationship between race and ethnicity and breast cancer stage, treatments, and survival rates.

Their study results showed that:

  • African-Americans, American Indians, Hawaiians, Indians and Pakistanis, Mexicans, South and Central Americans, and Puerto Ricans were 1.4 to 3.6 times more likely to be diagnosed with stage IV (advanced) breast cancer, compared to non-Hispanic white women;
  • African-Americans, Mexicans, and Puerto Ricans were 20% to 50% more likely to receive surgery and radiation treatment not recommended by the National Comprehensive Cancer Network standards for breast cancer; and,
  • African-Americans, American Indians, Hawaiians, Vietnamese, Mexicans, South and Central Americans, and Puerto Ricans were at 20% to 200% times greater risk of dying from breast cancer.

Dr. Li and his colleagues also found that non-Hispanic white women were often diagnosed with breast cancer at an older age. This is likely due to the fact that white women are more likely to use hormone replacement therapy (HRT), and long-term hormone use has been linked to an increased risk of post-menopausal breast cancer.

The researchers also reported that African-Americans, Hispanic whites and American Indians were more likely to be diagnosed with large tumors that had already spread past the breast to the nearly lymph nodes, compared to non-Hispanic whites and Asians and Pacific Islanders.

A previous study found that, overall, economic status affects breast cancer diagnosis, treatment, and survival more than race. In the April 3, 2002 issue of the Journal of the National Cancer Institute, Cathy J. Bradley, PhD, of Michigan State University, and her colleagues reported that women on Medicaid were significantly more likely to be diagnosed with advanced breast cancer and over 60% more likely to die from breast cancer than women with higher income levels who had private health insurance. (Uninsured women were even more likely than Medicaid recipients to be diagnosed with late-stage breast cancer). However, African-Americans were still less likely than white women to receive breast cancer surgery, even when the researchers factored in the Medicaid data.

Women with low income levels are often eligible to participate in the Centers for Disease Control’s (CDC) National Breast and Cervical Cancer Early Detection Program, which provides access to free preventive mammograms and Pap smears for qualifying women. The program also covers the treatment of cancers detected through the screening program.

Additional Resources and References

  • The report, "Differences in Breast Cancer Stage, Treatment, and Survival by Race and Ethnicity," is published in the January 13, 2002 issue of Archives of Internal Medicine,
  • The report, "Race, Socioeconomic Status, and Breast Cancer Treatment and Survival," is published in the April 3, 2002 issue of the Journal of the National Cancer Institute,