Race gaps seen in breast cancer awareness

By Anne Harding

NEW YORK (Reuters Health) - Even after undergoing breast cancer surgery, about half of women don't know that survival rates with removal of the cancerous portion of the breast only, along with radiation treatment, are equal to those seen with removal of the entire breast.

African-American and Hispanic women were less likely than whites to have this information, Dr. Sarah T. Hawley of the University of Michigan Health System in Ann Arbor and her colleagues found. Furthermore, this racial disparity in knowledge was the same even among women who received treatment at the highest-quality cancer centers, from the most experienced surgeons.

"We feel like it probably has a lot more to do with the way the providers are communicating information to patients" than with the overall quality of care itself, Hawley noted in an interview with Reuters Health.

Five-year survival rates after breast-conserving surgery (BCS), or lumpectomy, along with radiation for early-stage breast cancer are now known to be the same as those for mastectomy, in which the entire breast is removed, Hawley and her team note in their report in the latest online issue of Health Services Research.

However, the percentage of women who undergo mastectomy for early-stage disease remains high in certain parts of the country, they add. This has "raised concerns that many women may not be fully informed about surgical treatment options."

To investigate, the researchers surveyed 1,132 patients in Detroit and Los Angeles who had already undergone treatment for early-stage breast cancer, along with 277 surgeons.

Overall, 51 percent of the women were aware that five-year survival after BCS with radiation was the same as it was after mastectomy, the investigators report.

Nearly three-quarters of the women surveyed said that their surgeon had discussed both treatment options with them, and these women were more likely to understand that survival rates were the same for both options. In 20 states, including Michigan and California, the researchers note, surgeons are required by law to discuss both treatment options with eligible patients.

Nonetheless, while 57 percent of the white women in the study had survival knowledge, just 34 percent of African-American women and 37 percent of Latinas and women from other ethnic groups did.

"Perhaps the most concerning finding from this analysis was the persistence of racial/ethnic differences in breast cancer treatment knowledge despite controlling for surgeon characteristics, treatment location, and patient-surgeon communication," the researchers write.

Deciding what type of treatment to have can be "overwhelming" for women with breast cancer, Hawley noted, especially when they are under pressure to make that decision quickly. She and her colleagues are now developing tools to help surgeons communicate with breast cancer patients more effectively about their treatment options, and also investigating when in the course of treatment women would prefer to have this discussion.

SOURCE: Health Services Research, online 2008.