Why Do African-Americans Fare Worse With Cancer? Access and Economics Are Only Part...

Why Do African-Americans Fare Worse With Cancer? Access and Economics Are Only
Part of the Story
An analysis of clinical trial data implicates biological factors behind worse
outcomes for African-Americans with breast, ovarian, or prostate cancer.

ANN ARBOR, Mich., July 7 /PRNewswire-USNewswire/ -- An analysis of almost
20,000 patient records from the Southwest Oncology Group's database of
clinical trials finds, for the first time, that African-American breast,
ovarian, and prostate cancer patients tend to die earlier than patients of
other races even when they get identical medical treatment and other
confounding socioeconomic factors are controlled for. The finding points to
biological or host genetic factors as the potential source of the survival
gap.

"When you look at the dialogue about the issue of race and cancer survival
that's gone on over the years," says the paper's lead author, Kathy Albain,
M.D., a breast and lung cancer specialist at Loyola University's Cardinal
Bernardin Cancer Center, "it always seems to come down to general conclusions
that African-Americans may in part have poorer access to quality treatment,
may be diagnosed in later stages, and may not have the same standard of care
delivered as Caucasian patients, leading to a disparity in survival."

The study, which will be published online by the Journal of the National
Cancer Institute (JNCI) on July 7, found that when treatment was uniform and
differences in tumor prognostic factors, demographics, and socioeconomic
status were controlled, there was in fact no statistically significant
difference in survival based on race for a number of other cancers -- lung,
colon, lymphoma, leukemia, and multiple myeloma.

"The good news is that for most common cancers," Albain says, "if you get good
treatment, your survival is the same regardless of race. But this is not the
case for breast, ovarian, and prostate cancers."

Even with good treatment by the same doctors, African-American patients with
one of these three cancers faced a significantly higher risk of death than did
other patients, ranging from a 21% higher risk for those with prostate cancer
to a 61% higher risk for ovarian cancer patients.

The elimination of treatment and socioeconomic factors as the cause of this
higher mortality "implicates biology," says study co-author Dawn L. Hershman,
M.D., of the Columbia University College of Physicians and Surgeons.

"There may be differences in genetic factors by race that alter the metabolism
of chemotherapy drugs or that make cancers more resistant or more aggressive,"
she adds.

Hershman published a smaller study last month that found that, at least with
breast cancer, disparities in survival based on race persist even after
adjusting for differences in treatment. That study, published in the Journal
of Clinical Oncology, analyzed data on 634 breast cancer patients.

"Our study of multiple cancers is distinguished from others that have looked
at race-based disparities by its size and by the source of its data," says
Joseph Unger of the Southwest Oncology Group's Statistical Center, who was
statistician and co-author on the new JNCI study.

The study analyzed records from 35 clinical trials - going back as far as 1974
- that had been conducted by the Southwest Oncology Group, an NCI-sponsored
cooperative group headquartered at the University of Michigan. Using data
from clinical trials, which are already controlled for a range of potentially
confounding factors such as differences in diagnosis, treatment, and
follow-up, helps throw the remaining factors into sharper relief, according to
Frank L. Meyskens, Jr., M.D.

"It's because of the similar way that people are treated on clinical trials
that these differences are even detectable," he says. Meyskens is associate
chair for Cancer Control and Prevention for the Southwest Oncology Group and
director of the University of California-Irvine's Chao Family Comprehensive
Cancer Center.

The urgency of addressing the reasons for racial disparities in outcomes -
both sociological and biological - is amplified by another recent study in the
Journal of Clinical Oncology. It predicts the cancer incidence among
minorities will nearly double in the coming decades, increasing 99% by 2030
compared to an expected 31% increase among whites.

And the American Society of Clinical Oncology, the field's premier
professional organization, recently issued a "Disparities in Cancer Care"
policy statement that recommends a set of strategies for improving outcomes
for minority cancer patients.

"The elimination of socioeconomic and healthcare access disparities must be a
priority in the United States," says Lisa Newman, M.D., director of the Breast
Care Center at the University of Michigan Comprehensive Cancer Center.
"However, Dr. Albain's landmark study demonstrates that further investigation
of race- or ethnicity-associated differences in primary tumor biology is also
important."

John Crowley, Ph.D., of the Southwest Oncology Group Statistical Center and
Charles A. Coltman, M.D., of the University of Texas Health Science Center
were also coauthors of the study, which was funded by the National Cancer
Institute.

The Southwest Oncology Group (swog.org) is one of the largest cancer clinical
trials cooperative groups, with a network of almost 5,000
physician-researchers practicing at more than 500 institutions, including 19
of the National Cancer Institute-designated cancer centers. The Group is
headquartered at the University of Michigan in Ann Arbor, Mich.
(734-998-7140). The Group has an operations office in San Antonio, Texas and a
statistical center in Seattle, Wash.

SOURCE Southwest Oncology Group

Frank DeSanto of Southwest Oncology Group, +1-734-998-0114,
fdesanto@umich.edu