January 9, 2006

For Latinas, Cancer Treatment is a Family Affair

By Charnicia E. Huggins

NEW YORK -- Many Latin women with breast cancer rely on family members to decide on the type of treatment they should receive, according to new study findings, which may offer insight into the disparities observed in breast cancer treatment among minority groups.

"Family is the chief decision maker" in older Latina patients with breast cancer, study author Dr. Rose C. Maly, of the University of California at Los Angeles, told Reuters Health. She added that "it is a family affair and has to be addressed as such."

Previous research has shown that African-American and Latin women diagnosed with breast cancer are less likely to receive breast-conserving surgery and more likely to die from the disease than their white counterparts. In the current study, Maly and her team looked at the racial and ethnic differences in treatment decision-making among older breast cancer patients and the impact of such decisions on the treatment received.

They analyzed survey responses from 99 Latina, 66 African-American and 92 white women, 55 years or older, identified via the Los Angeles Cancer Surveillance Program. All of the women had been diagnosed with primary breast cancer in the previous three to nine months and were one month past their last treatment with surgery, chemotherapy or radiation.

The investigators found that mastectomy was more common among Latinas than among African-American and white women, whereas breast-conserving surgery (lumpectomy) was more common among African-American and white women than among Latinas.

Nearly 46 percent of Latin women underwent mastectomy, compared with 36 percent of African-American women and 25 percent of white women. In contrast, 75 percent of white women underwent breast-conserving surgery, as did 64 percent of African-American women and 54 percent of Latin women, the report indicates.

The reason for the disparity in the type of treatment chosen may be partly explained by differences in decision-making among the three groups, the report suggests. Latinas, especially those who were less acculturated in terms of their English language skills, were up to eight times more likely than African-American and white women to identify a family member as the final decision-maker about their cancer treatment, the researchers report in the February 15th issue of the medical journal Cancer.

Nearly half (49 percent) of the less acculturated Latinas said that their final treatment decision was made by a family member. What's more, although 75 percent of the more acculturated Latinas said they had made their own decision, as did 70 percent of African-American and white women, respectively, a "substantial minority" -- 18 percent -- of these Latinas also said they had relied on family members, the report indicates.

Less than 4 percent of African-American and white women said they had relied on a family member or friend to make that final decision.

Women who identified family members as the final treatment decision-makers were approximately 60 percent less likely to receive breast-conserving surgery, the researchers note.

Recent studies suggest that patients who undergo breast-conserving surgery function better physical than those who undergo mastectomy. Further, a study conducted among older patients showed that those who underwent breast-conserving surgery benefited just as much as younger women did in body image, disruption of daily habits and sense of insecurity.

Why family members were more inclined to choose mastectomies over lumpectomies was based on their "misconception that mastectomy was more curative than lumpectomy," Maly said, adding that the family member making the treatment decision "wanted to make sure the women survived."

Describing the core value of "familismo" in Latin culture, which emphasizes the importance of family, Maly said that doctors need to realize that family members who accompany cancer patients are "not merely translators or there to provide social support, they're actually making the decision."

Consequently, family members need to be educated as much as -- or more --than patients do. Likewise, family members need to "make it clear that they need just as much information as the patient," Maly said.

SOURCE: Cancer, February 15, 2006.