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Women's Health

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Minority women are nearly twice as likely as white women to not receive needed postoperative treatments for early-stage breast cancer

A new study underscores the many missed opportunities to optimize outcomes among women with early-stage breast cancer, especially minority women. Following surgery for early-stage breast cancer, minority women were nearly twice as likely as white women to not receive recommended treatments, even after taking into account important clinical (such as cancer stage and coexisting medical conditions), demographic (age), and care access (such as insurance and referral to a medical oncologist) factors that might affect treatment. While necessary to reduce treatment disparities, oncology referrals are not sufficient to ensure women's receipt of efficacious adjuvant treatment following surgery, conclude the researchers who conducted the study. They reviewed all inpatient and outpatient medical records of 677 women who underwent surgery for early-stage breast cancer in 1999 and 2000 at 6 New York City hospitals. They defined stage 1A cancer as a tumor less than 1 cm with good prognostic features.

One-fifth (21 percent) of all women, but nearly twice as many minority women, did not receive appropriate adjuvant therapy: 16 percent of whites, 34 percent of blacks, and 23 percent of Hispanics. Among the 396 women who underwent breast-conserving surgery, 73 percent of black women versus 84 percent of other women received recommended post-operative radiation. Among the 126 women with greater than stage 1A estrogen receptor-negative tumors, black women were less likely than other women to receive chemotherapy (67 vs. 78 percent). Among the 421 women with greater than stage 1A hormone-receptor-positive tumors, black and Hispanic women were less likely than other women to receive anti-estrogen therapy such as tamoxifen (71 and 75 percent, respectively, vs. 80 percent). Among women who could benefit from systemic treatment, 82 percent referred to a medical oncologist received it compared with 32 percent of nonreferred women. The study was supported in part by the Agency for Healthcare Research and Quality (HS10859).

See "Missed opportunities: Racial disparities in adjuvant breast cancer treatment," by Nina A. Bickell, M.D., M.P.H., Jason J. Wang, Soji Oluwole, M.D., and others, in the March 20, 2006, Journal of Clinical Oncology 24(9), pp. 1357-1362.

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