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Blacks Fare Worse With Esophageal Cancer

Blacks Half as Likely as Whites to Get Important Surgery, Study Shows
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WebMD Health News

Jan. 18, 2005 -- Blacks with esophageal cancer fare worse than whites in just about every category, and the difference can be life or death.

The racial gap was spotted by researchers including Ewout Steyerberg, PhD, of the public health department in Rotterdam, the Netherlands. Their findings appear in The Journal of Clinical Oncology's Jan. 20 edition.

Steyerberg is Dutch, but the data comes from America. The researchers studied Medicare records of about 3,300 elderly patients with cancer of the esophagus -- the hollow, muscular tube that connects the mouth to the stomach.

Almost 3,000 of the patients were white. The rest were black.

Typically, fewer than 10% of esophageal cancer patients survive five years, say the researchers. However, surgery can make a big difference. About 20% live disease-free for at least five years if surgery removes their cancer before it spreads.

In the study, black patients were half as likely to get esophageal cancer surgery as whites. They were also less likely to consult a surgeon and more likely to die.

A quarter of blacks got surgery, compared with 46% of whites. More blacks than whites relied on radiation as their only treatment (20% vs. 13%). In addition, more blacks than whites didn't get any cancer treatment at all (26% vs. 15%).

Blacks were also less likely to be seen by a surgeon -- 70% of black patients compared with 78% of whites.

Fewer blacks who talked to surgeons went ahead with surgery. Almost a third of black patients who had a surgical consultation had surgery. But among whites who had a surgical consultation, nearly 60% underwent surgery.

That might explain why blacks had a lower survival rate at every turn. For example, six months after being diagnosed 64% of white patients were alive compared with 58% of blacks. Two years after diagnosis 25% of whites were alive compared with 18% of blacks.

Blacks were about two years younger than whites, on average (72 vs. 74 years). However, they were more likely to have other medical conditions, such as heart disease, diabetes, and kidney problems.

Still, medical problems don't totally explain the gap, say the researchers. They urge health care providers to do a better job of encouraging black patients to consult surgeons and consider surgery's benefits.

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