Among women with node-positive breast cancer, Black women are less likely than White women to receive adjuvant (post-surgery) treatment with chemotherapy and/or hormonal therapy. These results were published in the journal Cancer.
Cancer incidence and survival in the U.S. continues to vary by race and ethnicity. In the case of breast cancer, Black women are less likely than White women to be diagnosed with the disease but more likely to die from it. Even among women with the same stage of breast cancer, Black women have worse survival.
Survival differences among women with the same stage of breast cancer may be explained by factors such as differential access to healthcare, differences in gene expression or tumor biology, or within-stage differences in tumor size or number of involved lymph nodes.
To explore whether Black and White women receive different treatment for breast cancer, researchers conducted a study among 630 women diagnosed with breast cancer between 1990 and 1996 at a cancer center in Detroit, Michigan. A total of 388 of the study participants were Black and 242 were White. None of the women had distant metastases (cancer that had spread to distant sites in the body).
The study assessed type of surgery (breast-conserving surgery or mastectomy), as well as adjuvant (post-surgery) use of chemotherapy and hormonal therapy. Hormonal therapies, such as tamoxifen, are often used in the treatment of hormone receptor-positive breast cancers.
- Type of surgery (breast conserving surgery or mastectomy) did not differ significantly by race.
- Among women with cancer confined to the breast, use of chemotherapy and/or tamoxifen did not differ significantly by race.
- Among women with regional breast cancer (cancer that had spread to nearby tissues such as the lymph nodes), White women were more than three times more likely than Black women to receive chemotherapy, and almost five times more likely to receive tamoxifen.
- Receipt of chemotherapy also varied by marital status. After accounting for race and several other factors, married women were more likely than nonmarried women to receive chemotherapy for regional breast cancer. Receipt of tamoxifen did not vary by marital status.
While the reason for these treatment differences is unclear, differences in treatment may explain some of the observed differences in breast cancer survival between Black and White women.
Reference: Banerjee M, George J, Yee C, Hryniuk W, Schwartz K. Disentangling the effects of race on breast cancer treatment. Cancer [early online publication]. October 8, 2007.