New research published in the July issue of the Journal of the American College of Surgeons reveals that African Americans with gastrointestinal stromal tumors (GIST), a rare cancer that begins in the wall of the gastrointestinal tract, now have survival rates equivalent to those of Caucasians. Prior to 2000, African Americans were more likely to develop GIST and less likely to undergo surgical treatment for this type of cancer.
Racial disparities in survival rates have been demonstrated for a number of cancers, typically due to unequal access to care. Through the National Institutes of Health and Healthy People 2010, a national health promotion and disease prevention initiative, the federal government has set forth goals to explore, account for and minimize these disparities.
"Over the last decade, racial gaps in the treatment of GIST appeared to have closed," said Michael Cheung, MD, DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine. "Both perioperative and long-term survival have improved among African Americans."
"Our study suggests that better diagnosis and increased use of surgery – which still provides the best chance for cure – have contributed to improvements in care for African Americans," said Leonidas G. Koniaris, MD, FACS, associate professor of surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and surgical oncologist at Sylvester Comprehensive Cancer Center at UM. "In addition, increased access to new targeted therapies through medication assistance programs may be helping to eliminate racial disparities in cancer treatment."
A statistical analysis was performed using the Surveillance, Epidemiology and End Results (SEER) database that identified 3,795 patients diagnosed with GIST and other intestinal mesenchymal tumors between1992 to 2005. Patient demographics showed 72.2 percent Caucasians, 15.6 percent African Americans, and 9.1 percent Hispanics. Survival was calculated from the time of initial diagnosis to the date of last contact or death.
Both perioperative and long-term survival had improved among African Americans since 2000. In patients diagnosed before the year 2000, 30-day surgical mortality was higher in African Americans (0.56 percent versus 0.76 percent Caucasians, p=0.012). After 2000, 30-day surgical mortality was equivalent between races (0.46 percent versus 0.35 percent for Caucasians, p=0.517).
Before the year 2000, three-year disease specific survival was better in Caucasians than African Americans (79.3 percent versus 75.1 percent, p=0.025). There was no racial difference in tumor stage (p=0.446) or grade (p=0.495), and African Americans underwent surgical procedures less frequently than Caucasians (p=0.003). Multivariate analysis correcting for patient demographics, socioeconomic status and clinical data demonstrated African American race and failure to undergo surgical treatment were independent predictors of poor prognosis. In patients diagnosed after 2000, three-year disease specific survival was nearly equivalent between Caucasians and African Americans (82.1 percent versus 80.7 percent, p=0.680) and African Americans underwent surgical procedures just as often as Caucasians (p=0.153) did. Multivariate analysis for patients diagnosed after 2000 demonstrated no difference in survival by race (p=0.126).