Breast Cancer Death Found More Likely for Blacks Despite Care Level

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 black women have a higher mortality rate from breast cancer, but it 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, black women are less likely than whites to get breast cancer, but their death rate is higher.

Authorities have long presumed that the reason for the higher mortality rate 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 who were diagnosed and treated for breast cancer 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 with breast cancer treated at military health care facilities had a lower mortality rate, 24.8% after five years, than did black women in the nation at large, 34.2%. Those statistics, she said, suggest that the ready access 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 elsewhere.

Therefore, 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 still 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,” she said.

Another researcher at the conference discussed efforts to develop a new breast cancer treatment, by 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, in which the cancer patient receives “a young immune system.”

The 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 that is 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 to be 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, they will be followed for three years for conformance to the diet and any recurrence of breast cancer, she said. The women undergo individual and group counseling and unannounced interviews to help them adhere to the regimen, she said.