July 13, 2009

African-Americans Fare Worse With Some Cancers

An analysis of almost 20,000 patient records from the Southwest Oncology Group's database of clinical trials finds that African-American breast, ovarian, and prostate cancer patients tend to die earlier than patients of other races, even when they get identical medical treatment and other socioeconomic factors are controlled. The finding points to biological or genetic factors as the potential source of the survival gap.

The study also found that when treatment was uniform and differences in tumor prognostic factors, demographics, and socioeconomic status were controlled, there was no significant difference in survival based on race for a number of other cancers -- lung, colon, lymphoma, leukemia, and multiple myeloma

"When you look at the dialogue about the issue of race and cancer survival that's gone on over the years," the paper's lead author, Kathy Albain, M.D., a breast and lung cancer specialist at Loyola University's Cardinal Bernardin Cancer Center is quoted as saying, "it always seems to come down to general conclusions that African-Americans may in part have poorer access to quality treatment, may be diagnosed in later stages, and may not have the same standard of care delivered as Caucasian patients, leading to a disparity in survival."

"The good news is that for most common cancers," Albain says, "if you get good treatment, your survival is the same regardless of race. But this is not the case for breast, ovarian, and prostate cancers."

The urgency of addressing the reasons for racial disparities in outcomes "“ both sociological and biological "“ is amplified by another recent study in the Journal of Clinical Oncology, which predicts the cancer incidence among minorities will nearly double in the coming decades, increasing 99 percent by 2030, compared to an expected 31 percent increase among whites.

This study analyzed records from 35 clinical trials "“ going back as far as 1974 "“ that had been conducted by the Southwest Oncology Group, an NCI-sponsored cooperative group headquartered at the University of Michigan. Using data from clinical trials, which are already controlled for a range of potentially confounding factors, helps throw the remaining factors into sharper relief, according to Frank L. Meyskens, Jr., M.D.

"It's because of the similar way that people are treated on clinical trials that these differences are even detectable," Meyskens, who is associate chair for Cancer Control and Prevention for the Southwest Oncology Group and director of the University of California-Irvine's Chao Family Comprehensive Cancer Center is quoted as saying.

"The elimination of socioeconomic and healthcare access disparities must be a priority in the United States," says Lisa Newman, M.D., director of the Breast Care Center at the University of  Michigan Comprehensive Cancer Center. "However, Dr. Albain's landmark study demonstrates that further investigation of race- or ethnicity-associated differences in primary tumor biology is also important."

SOURCE:  Journal of the National Cancer Institute (JNCI), July 7, 2009