Decades of social progress fail to achieve equality in cancer care

What the U.S. is doing wrong in the fight against breast cancer among African Americans continues to elude the medical community.

Research at The George Washington University has found that African American women diagnosed with breast cancer between 2001 and 2003 were significantly more likely to wait for treatment than if they had been diagnosed between 1998 and 2000. And the gap between diagnosis and treatment is getting wider. Those diagnosed between 2004 and 2006 waited longer for treatment than those between 2001 and 2003.

Heather A. Young, Ph.D., an associate professor of epidemiology, and her colleagues at the university documented this trend but they can’t explain it.

“There is likely something about race that we are still not capturing. Whether it is different patterns of social support, access to transportation, or family burden, something is causing the disparities in care to persist,” Young said.

Young reported at the Third AACR Conference on the Science of Cancer Health Disparities that African American women living with breast cancer in Washington, DC, are more likely to experience delays in treatment regardless of insurance type, socioeconomic status, and cancer characteristics such as stage and grade.

There was reason for hope 20 years ago that the disparity between African Americans and whites could be explained. Researchers reported success in relating the causes of increased cancer morbidity and mortality in African Americans more to poverty and lack of education and access to care than to any inherent racial characteristics.

The recently released GWU findings, however, underscore the difficulties in measuring the impact of race and socioeconomic status on health outcomes, said Young, whose research captured socioeconomic status, but only by drawing poverty status from U.S. Census data.

“We have yet to fully capture the spectrum of variables that encompass socioeconomic status,” she said.

Because the work focused just on Washington, DC, Young restricted her comments to this subpopulation of patients, noting that the treatment for African American women in DC lags behind recommendations found in professional guidelines and is significantly longer than what is seen for white women. She speculates, however, that “the situation is likely similar or worse in other urban areas, which may have higher rates of uninsured.”

Using data from the DC Cancer Registry, which captured all cancer cases from 1998 to 2006, the researchers found that African American women were 2.19-fold more likely to wait more than two months longer than white women from the time of diagnosis to treatment. African American women in the study had a mean time to diagnosis of 26.1 days compared with 14.1 days for white women.

This disparity between African American and white women increased over time, as the gap widened in data extending from 1998 to 2006.

More than just the findings of a disparity, this trend toward lengthier waits for African American women is cause for grave concern for health providers in the U.S., as matters appear to be getting worse rather than better and no one knows for sure why.