A new study finds that older African-American women are significantly less likely than Caucasian women to receive the standard of care for early-stage breast cancer, namely, lumpectomy followed by radiation treatment. The study included 34,080 women in a national Medicare database, of whom 91% were white and 6% were black (3% were members of another race). The women were at least 65 years of age (average age, 76 years) and were treated for invasive breast cancer in 2003. The results were adjusted based on disease characteristics, as well as demographic and socioeconomic covariates. Caucasian women were found to be significantly more likely to receive radiotherapy than African-American women. Approximately 74% of Caucasians and 65% of African Americans received radiation treatment after surgery.

The racial differences in treatment were found to vary according to geographic region. African-American patients in areas of the northeastern and southern United States had the lowest rates of radiotherapy use (57% in these locales). However, in the mountain West (76% of Caucasians versus 74% of African Americans) and the north central Midwest (74% vs. 72%), there was little difference in the rates based on race. Racial disparities were found both in patients between 65 and 70 and those over 70. The authors conclude that substantial racial disparities in radiotherapy use after lumpectomy exist across much of the U.S.

Risk of breast cancer is lower, but prognosis is poorer for African Americans

Numerous studies have found that while African-American women are less likely to get breast cancer than Caucasian women, they are more likely to die should they be diagnosed. A number of reasons have been proposed for this disparity, including the fact that African-American women are more likely to be diagnosed at later stages with more aggressive forms of the disease. However, as this study demonstrates, this is not the whole story.

The striking disparity in radiation treatment after lumpectomy in parts of the northeast and south is likely the result of a combination of factors. While failing to offer radiation treatment in such a way that makes it likely for a woman to accept the treatment may not be intentional, it is still harmful. Overworked oncology providers who are accustomed to the aggressive approach to all aspects of their disease adopted by many upper middle class women may not recognize the need to take the time to educate and support less educated women of color in their decision making. These are some of the very women who most rely their doctors to take care of them when faced with a life threatening disease. However, it is apparent that, all too often, this group is not being properly cared for. On the other hand, there may be transportation and other obstacles that make it difficult for older disadvantaged women to complete a daily schedule of radiation treatments for many weeks. Cancer care providers and programs serving the poor (including mammogram screening outreach programs) should be prepared to offer information concerning possible sources of relevant assistance to those who need it to overcome barriers to care.