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Poverty, Not Race, the Key to Breast Cancer Outcome

Study: Poor fare worse whether they're black or white

TUESDAY, April 2, 2002 (HealthDayNews) -- If you want to predict a woman's chances of surviving breast cancer, don't look at her race. Look at how much -- or, better yet, how little -- she earns.

Researchers have long known that African-American women are more likely to get diagnosed with breast cancer at a later stage and to have poorer prognoses than white women. No one has been sure, however, whether these differences were due to race or socioeconomic status.

Now researchers at Michigan State University have completed a study, appearing in the April 3 issue of the Journal of the National Cancer Institute, indicating that the socioeconomic part of the equation is most responsible for these differences.

"In some ways this is good news because we can change people's socioeconomic status," says Cathy Bradley, lead author of the study and a health economist and an associate professor of medicine at Michigan State University. "It's a lot of work and we have to really make some sacrifices, but we can do it. We can improve health care to low-income people."

The findings also help lay to rest various theories about biological factors being responsible for differences in the disease's course.

"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 have-nots," writes Dr. Otis W. Brawley of Emory University's Winship Cancer Institute in Atlanta in an editorial.

Bradley and her team analyzed data from the Detroit cancer registry along with Medicaid enrollment files. Of 5,719 women with breast cancer, 593 were insured by Medicaid and had income levels below the federal poverty line. The rest either had private insurance or no insurance.

At first, it looked like race played a huge role in how African-Americans with breast cancer fared. These women were 53 percent more likely than white women to be diagnosed with later-stage disease, 26 percent less likely to receive radiation after breast-conserving surgery, more than twice as likely to receive no surgery, and 39 percent more likely to die.

When the data were adjusted, however, most of the differences disappeared. One exception was surgery: African-American women were 62 percent more likely to have no surgery than white women. Those who did have surgery were 63 percent more likely to receive breast-conserving surgery.

Various socioeconomic factors shed more light on the picture. Regardless of race, women insured by Medicaid were 41 percent more likely to be diagnosed with late-stage breast cancer, 44 percent less likely to receive radiation after breast-conserving surgery, and three times more likely to die than women not insured by Medicaid.

Privately insured women were usually diagnosed earlier than women on Medicaid who, in turn, tended to be diagnosed earlier than uninsured women.

Poverty, then, was a bigger risk factor than race in regard to late diagnosis, receiving less-than-optimal treatment and survival rates.

"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 have-nots," writes Brawley in the same editorial.

The problem in the United States (and much of the world) is that race is intimately intertwined with poverty. In this study, 13 percent of white women lived in areas with a a high poverty level, while 84 percent of African-American women lived in such areas.

"We have higher proportions of African-Americans who are low income, so they tend to suffer greatly in terms of disparities because they're in a lower socioeconomic group and that makes them more vulnerable," Bradley says.

One partial solution to this problem is to give poor women better health coverage. Women already diagnosed with breast cancer can become eligible for Medicaid. The trick is to have them covered before they get sick so they can take advantage of preventive care. "Anything we can we do to ease that burden, to provide continuous coverage so low-income women get access to screening and care so that preventive health becomes part of their lives, then we can the change course of the disease," Bradley says.

What To Do

For more information on African-Americans and breast cancer check out this site from the National Women's Health Network.

The National Institutes of Health has loads of information on all aspects of African-American health, including breast cancer.

SOURCES: Cathy Bradley, Ph.D., associate professor, department of medicine, Michigan State University, East Lansing; April 3, 2002 Journal of the National Cancer Institute
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