Disparities in breast cancer treatment: African-American women diagnosed in later stages of disease

Study confirms previous results of government health plans in commercial plan population

Cancer, the peer-reviewed international journal of the American Cancer Society, has published a study conducted by HealthCore, Inc. in its Jan. 1 edition, demonstrating disparities in breast cancer treatment between commercially insured African-American and white women.

The HealthCore study reiterates the findings of previous studies - conducted in populations using government health programs - that African-American women are diagnosed in later stages of the disease.

Breast cancer is the second most common cause of cancer death in white and African-American women in the United States.

"This study demonstrates that disparities in breast cancer care exist even when patients have access to employer-provided healthcare," said Dr. Joe Singer, HealthCore vice president for clinical affairs. "A key takeaway from our study is that African-American women were diagnosed with breast cancer at younger ages, but in later stages of breast cancer, when chances of survival diminish greatly."

The study, funded by Amgen, was conducted in collaboration with Blue Cross and Blue Shield of Georgia and the American Cancer Society. HealthCore is working with Blue Cross and Blue Shield of Georgia and the American Cancer Society to further evaluate the study to understand more about the women who are newly diagnosed with breast cancer so the health plan can determine better ways to communicate with them and their physicians in an attempt to diminish the disparities.

The HealthCore study also found that not all women who tested positive for hormone receptor cancer received anti-estrogen therapy, which is a standard of care set by guidelines established by the National Comprehensive Cancer Network and the American Cancer Society. Of those women who did test positive, white women were more likely than African-American women to receive anti-estrogen therapy.

Specifically, the study found:

• White women (55.2 percent) were more likely than African- American women (38.4 percent) to be diagnosed with stage 0 or stage I disease.
• Twice as many African-American women (6.1 percent) compared with white women (3.6 percent) were diagnosed with stage IV disease.
• Among women who tested positive for hormone receptor cancer, African-American women were less likely to receive treatment, such as aromatase inhibitors or tamoxifen.
• White women were twice as likely to receive anti-estrogen therapy compared with African-American women, after adjusting for age, cancer stage, and social economic status.

"While treatment for depression and anxiety occurred in both groups, less than half of those women had notes in their medical charts to follow-up with their primary care physician and only one women was referred to a mental health professional," said Dr. Otis Brawley, chief medical officer for the American Cancer Society and study co-author. "Clearly, this is a health intervention needed for both African-American and white women."