April 3, 2002 -- African-American women with breast cancer are more likely to die of their disease than are white women. Some have suggested that breast cancer behaves more aggressively in blacks, but new research finds that economic status, and not race, is responsible for the disparity.
Poor women with breast cancer were three times more likely to die than were women who were not poor in a study conducted by Michigan State University researchers. The study found low socioeconomic status to be associated with later-state breast cancer diagnosis, less adequate treatment, and a poorer prognosis. Race, alone, did not appear to be linked with breast cancer outcome.
"The message here is that if you are poor and have cancer, your outcome is likely to be much worse than if you are not poor," lead author Cathy J. Bradley, PhD, tells WebMD. "We can do so much today to detect breast cancer early and give women a positive prognosis. But these advances are not extending to women of low socioeconomic status. We have a two-tiered system."
Bradley and colleagues identified almost 6,000 women with breast cancer using the Detroit cancer registry, and then cross-referenced the list with Medicaid rolls to find 593 patients with incomes below the federal poverty level. The researchers then compared the outcome of the Medicaid recipients with the other women. After adjusting for race and other factors, the women on Medicaid were found to be 41% more likely to have their breast cancer diagnosed at a late stage and were 44% less likely to receive radiation. Three times as many women on Medicaid died from their breast cancer as women who were not low income.
The research was reported April 3 issue of the Journal of the National Cancer Institute and was funded by grants from the National Cancer Institute and the Michigan Department of Community Health.
In an editorial accompanying the study, Otis W. Brawley, MD, noted that the new research should help focus the debate on access to medical care. Brawley is with the Winship Cancer Institute at Emory University in Atlanta.
"Rather than speaking in racial/ethnic terms of black and white populations, it is more appropriate to speak in socioeconomic terms of the 'haves' and the 'have-nots,'" he wrote. "This focus would rightfully bring other socio-economically deprived populations that include whites, Hispanics, Native Americans, and Asians into the discussion."
In an interview with WebMD, Brawley says the emphasis on race has allowed policy makers and medical providers to accept the disparities in outcome as inevitable. The idea that biological differences are responsible for the high breast-cancer death rate among black women makes it easy to ignore the fact that many of these women get substandard care because they are poor.
"Equal treatment results in equal outcome," he says. "And there is not equal treatment for poor women."