Black and Hispanic women are less likely than white women to receive
the radiation therapy routinely prescribed following surgery for early
breast cancer, according to a study that Dana-Farber Cancer Institute
researchers will present at the annual meeting of the American Society
of Clinical Oncology in Chicago.
Although the disparity in rates is relatively small, the findings
suggest that thousands of black and Hispanic breast cancer patients may
be undertreated following a lumpectomy. The data (abstract 535) will be
presented during a poster session on Monday, June 2, 8 a.m. – 12 p.m.
CT, Lakeside Center Building, 450A.
Rachel Freedman, MD, an oncology fellow in Dana-Farber's Breast
Oncology Center, noted that although some women in all racial and ethnic
groups fail to receive the recommended course of radiation following
breast-conserving surgery (lumpectomy) — which has largely replaced
mastectomy for small, early breast tumors — black and Hispanic patients
have the lowest rates among all racial/ethnic groups studied.
The regimen calls for short sessions of radiation five days a week
for six to seven weeks, and "there are many barriers that may prevent
this from happening," Freedman noted. Often there are logistical
problems: distance to a radiation treatment facility, conflicts with
work, transportation and child care issues, she said. Other factors
include insurance status, possible lack of a recommendation for
radiation in older patients or those perceived to have lower risk
cancers, as well as patient preferences and priorities.
Freedman, along with senior author Nancy L. Keating, MD, MPH, of
Brigham and Women's Hospital and two other co-authors, analyzed cancer
registry data on 375,547 women with stage I or II breast cancer. They
calculated rates of receiving lumpectomy and radiation or mastectomy
(termed "definitive primary therapy") and the rates of having a
lumpectomy without radiation (non-definitive therapy) among
Compared with white women, black women had lower odds of receiving
definitive therapy (82.1 percent for blacks versus 86.1 percent for
whites). Hispanic women also had a lower rate, 83.2 percent, while the
rate among Asian women, 89.4 percent, was higher than it was for white
"The difference between blacks and whites may seem small percentage
wise — 4 percent — but if 200,000 women are diagnosed with early breast
cancer every year, 4 percent amounts to 8,000 women who are not receive
definitive primary therapy," said Freedman.
"We don't know the exact reasons for these disparities," Freedman
said. "We are interested in finding out what is happening in these
women, and subsequent studies need to examine how other factors have
contributed to these findings. In a follow-up study, we are examining
pertinent issues such as insurance status, education level, and income."
The other co-authors are Eric Winer, MD, of Dana-Farber, and Yulei
He, PhD, of Harvard Medical School's Department of Health Care Policy.
Dana-Farber Cancer Institute (www.dana-farber.org)
is a principal teaching affiliate of the Harvard Medical School and is
among the leading cancer research and care centers in the United States.
It is a founding member of the Dana-Farber/Harvard Cancer Center
(DF/HCC), designated a comprehensive cancer center by the National