Breast Cancer Deaths Not Linked to Care

Even when African American women with breast cancer receive identical health care to white women, black women are more likely to die of the disease, a researcher said Wednesday.

Further research is needed to explain why, but the reason cannot be attributed solely to unequal health care, said Barbara Wojcik, senior statistician with the U.S. Army’s Center for Healthcare Education and Studies.

Wojcik spoke at the American Cancer Society’s annual science writers seminar, where breast cancer research was discussed Wednesday. Other experts spoke about research into nutrition, the immune system, anti-estrogen therapy and less invasive surgical methods.

According to the American Cancer Society, while black women are less likely than white women to get breast cancer, their death rate is higher.

Authorities have long presumed that the reason is that African Americans have less access to affordable, regular health care.

So Wojcik looked at the cases of 6,577 white and African American women whose breast cancer was diagnosed and treated between 1975 and 1994 at military hospitals throughout the nation, where medical care is low cost, regular and presumably equal.

The cancer patients were either in the service or family members of someone in the service. Ninety percent of the women in the study were white, 10% were black.

Wojcik found that African American women treated at military health care facilities had a lower mortality rate, 24.77% after five years, than did black women in the nation at large, 34.2%. Those statistics, she said, suggest that the access to medical care at military facilities indeed improved African Americans’ chances of surviving breast cancer.

The mortality rate for white women with breast cancer was nearly the same--18%--whether they were treated at military facilities or in the nation at large.

But in an ethnicity comparison of black and white women receiving military health care, African Americans had a higher death rate by nearly 7%.

A “significant and unexplained difference still exists between African American and white military beneficiaries,” Wojcik reported. “This difference cannot be explained by access to health care.”

Researchers need to look at such factors as the biology of the tumors, socioeconomic status, cultural factors and diet to further explore the difference, she said. Her researchers are following up with surveys of participants to ask about these issues, she said.

Her research also revealed that African American women were getting earlier diagnoses of breast cancer at the military facilities, “an encouraging sign.”

Another researcher at the conference discussed efforts to develop a new breast cancer treatment, which involves injecting specially grown immune system cells that would attack the tumor.

James Mule, professor of surgery at the University of Michigan Medical Center, said clinical trials will begin this year on a procedure to be used in conjunction with a bone marrow transplant, when the cancer patient receives “a young immune system.”

Researchers will isolate hematopoietic stem cells, rare cells within the bone marrow, and grow “daughter cells” that will be genetically altered to go after an antigen expressed by breast cancer tumors, he said.

Another research team is studying the impact of dietary fat on breast cancer.

Research scientist Barbara Winters with the American Health Foundation reported on the progress of enrolling women across the nation in a nutrition study that is expected to reveal whether an extremely low-fat diet reduces the risk of breast cancer recurrence.

More than 1,400 women who have been treated for breast cancer are enrolled, with a total of 2,500 expected within three years, she said. The women are divided into one group that consumes a diet in which 30% of calories come from fat, and the test group, which restricts fat to 15% of all calories.

After all are enrolled, the women will be followed for three years for conformance to the diet and any recurrence of breast cancer, she said. The women receive individual counseling sessions, plus group sessions and unannounced interviews, to assist them in adhering to the regimen, she said.