Medical Concerns and Race

 

A debate is taking place on social media regarding medical concerns and the multiracial community. It is a life and death issue and should not be taken lightly. Some critics have stated that since race is a “social construct,” we are all the same biologically and there are no physical differences. Therefore, they believe, that any medical differences are non-existent and should not be studied further. They believe that the reason for not having racial classifications is that no human medical differences have been found.

Project RACE finds the critics short-sighted and their beliefs dangerous. Perhaps there are physical and/or neurological differences or maybe not. We just do not know, but that is not a reason to cancel medical studies and findings. It is not a reason to prematurely do away with racial categories, although there may be other reasons in other circumstances. We can look mostly at the area of the need for donor increase for life-saving bone marrow and the need for as close to a racial and ethnic match as possible. If there were no physical differences in these areas, why would race and ethnicity be important? Obviously, these include very specific requirements in the medical realm. We simply cannot act as if it doesn’t exist. Bone marrow matching by race and ethnicity is a critical life and death matter.

Tay-Sachs is a disease that affects mostly Jewish people. Sickle Cell Anemia is mainly found in African Americans. There are many more examples. Should we discount race as a factor in medicine? Absolutely not; we should be finding out more. We must take the high road and push for more information to be sought, unlike our critics.

It’s lovely to live in a world where you think there are no racial and/or ethnic differences and perhaps that is true, but the truth is we just don’t know—not enough work has been done. An article appeared in U. S. News and World Report by HealthDay Reporter Maureen Salamon on December 6, 2018 called “Breast Cancer Deadlier for Black Women, Despite Same Treatments, which was revealed by a new trial. They did adjust for lifestyle differences and found that some drugs were metabolized differently by racial groups. The article can be read here:

https://www.usnews.com/news/health-news/articles/2018-12-06/breast-cancer-deadlier-for-black-women-despite-same-treatments

And here is another plea; http://www.fox46charlotte.com/news/4-year-old-alameda-girl-diagnosed-with-rare-genetic-disorder-family-urging-donors-to-join-registry

We need more of these kinds of studies, not fewer. We need to enlarge the pool of multiracial donors for bone marrow, not act as though it’s not a problem. We have a long way to go to save lives. We can’t afford to turn away.

 

 

 

Photo Credit: Depositphotos

Medical Monday

Race, Ethnicity May Affect Breast Cancer Survival

New research finds biological differences in tumor type, behavior
 Your chances of being diagnosed with early breast cancer, as well as surviving it, vary greatly depending on your race and ethnicity, a new study indicates.

“It had been assumed lately that we could explain the differences in outcome by access to care,” said lead researcher Dr. Steven Narod, Canada research chair in breast cancer and a professor of public health at the University of Toronto. In previous studies, experts have found that some ethnic groups have better access to care.

But that’s not the whole story, Narod found. His team discovered that racially based biological differences, such as the spread of cancer to the lymph nodes or having an aggressive type of breast cancer known as triple-negative, explain much of the disparity.

“Ethnicity is just as likely to predict who will live and who will die from early breast cancer as other factors, like the cancer’s appearance and treatment,” Narod said.

In his study, nearly 374,000 women who were diagnosed with invasive breast cancer between 2004 and 2011 were followed for about three years.

The researchers divided the women into eight racial or ethnic groups and looked at the types of tumors, how aggressive the tumors were and whether they had spread.

During the study period, Japanese women were more likely to be diagnosed at stage 1 than white women were, with 56 percent of Japanese women finding out they had cancer early, compared to 51 percent of white women.

But only 37 percent of black women and 40 percent of South Asian women got an early diagnosis, the findings showed.

When the researchers calculated the seven-year risk of death, black women had the highest risk, with a 6 percent death rate. South Asian women (Asian Indian, Pakistani) had the lowest, at less than 2 percent.

And black women were nearly twice as likely as white women to die following the diagnosis of small tumors, according to the study published Jan. 13 in the Journal of the American Medical Association.

The new research “makes significant strides in explaining the well-known racial disparities in breast cancer,” said Dr. Bobby Daly, a hematology-oncology fellow at the University of Chicago Medical Center. He co-authored an editorial that accompanied the study.

“It makes strides in showing how the difference in survival may reflect intrinsic differences in the biology of the tumor,” he added.

However, there still needs to be improvements in access to care, treating women according to established guidelines and avoiding treatment delays, Daly noted.

Regardless of race or ethnicity, women should be aware of any family history of breast cancer, be aware of other risk factors they may have, and obtain appropriate screening with mammograms, he said.

Women in minority groups must also be included in greater numbers in future research, the authors of the editorial said.

Race and Breast Cancer

Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer

JAMA 2013 Jul 24;310(4)389-397, JH Silber, PR Rosenbaum, AS Clark, BJ Giantonio, RN Ross, Y Teng, M Wang, BA Niknam, JM Ludwig, W Wang, O Even-Shoshan, KR Fox

TAKE-HOME MESSAGE

As per a SEER database analysis, although significant differences in treatment exist between black and white women with breast cancer, these factors had minimal impact on the 5-year survival differences between these two racial groups. The worse survival outcomes of black women persist and appear to be related to disease characteristics at diagnosis rather than treatment differences.

Commentary by

Differences in outcome after a diagnosis of breast cancer for African-American women vs white women have been known and documented for decades. The root causes of this disparity continue to be debated, but boil down to biological differences in tumors, differences in treatment, more advanced presentation of disease at diagnosis (in part, related to reduced screening), and other comorbid conditions. In this article, Silber et al took another look at more contemporary data from the SEER database in the era of taxane-based adjuvant chemotherapy and used an innovative case-controlled matching statistical model to examine the impact of these various differences in terms of survival after breast cancer diagnosis.

They found a large decrement in 5-year survival for African-Americans, matched by demographics to whites, of 12.9%—a number that was reduced but still significant when presentation and treatment factors were also considered (differences of 4.4% and 3.6%, respectively). They concluded that presentation differences, including stage and ER status at diagnosis, were the most important factors explaining the disparity; treatment differences, specifically type of chemotherapy, contributed in a smaller proportion. They did note a difference in comorbidities, which also impacted survival. One deficiency of the study is the lack of information about endocrine therapy; so, the treatment differences could be much more marked than the model suggests.

The authors’ findings strongly endorse ongoing efforts to increase primary care for black women, increase screening and earlier detection of breast cancer, and close the remaining gap in treatment differences after cancer is detected. Understanding biological differences in breast cancer based on race, perhaps with regard to different phenotypic subtypes, should also be explored. While the disparity gap remains large, more attention to this issue is being paid, which, hopefully, will ultimately improve outcomes.


ABSTRACT

Importance: Difference in breast cancer survival by race is a recognized problem among Medicare beneficiaries.

Objective: To determine if racial disparity in breast cancer survival is primarily attributable to differences in presentation characteristics at diagnosis or subsequent treatment.

Design, Setting, and Patients: Comparison of 7375 black women 65 years and older diagnosed between 1991 to 2005 and 3 sets of 7375 matched white control patients selected from 99 898 white potential controls, using data for 16 US Surveillance, Epidemiology and End Results (SEER) sites in the SEER-Medicare database. All patients received follow-up through December 31, 2009, and the black case patients were matched to 3 white control populations on demographics (age, year of diagnosis, and SEER site), presentation (demographics variables plus patient comorbid conditions and tumor characteristics such as stage, size, grade, and estrogen receptor status), and treatment (presentation variables plus details of surgery, radiation therapy, and chemotherapy).

Main Outcomes and Measures: 5-Year survival.

Results: The absolute difference in 5-year survival (blacks, 55.9%; whites, 68.8%) was 12.9% (95% CI, 11.5%-14.5%; P  < .001) in the demographics match. This difference remained unchanged between 1991 and 2005. After matching on presentation characteristics, the absolute difference in 5-year survival was 4.4% (95% CI, 2.8%-5.8%; P < .001) and was 3.6% (95% CI, 2.3%-4.9%; P  < .001) lower for blacks than for whites matched also on treatment. In the presentation match, fewer blacks received treatment (87.4% vs 91.8%; P < .001), time from diagnosis to treatment was longer (29.2 vs 22.8 days; P < .001), use of anthracyclines and taxols was lower (3.7% vs 5.0%; P < .001), and breast-conserving surgery without other treatment was more frequent (8.2% vs 7.3%; P  = .04). Nevertheless, differences in survival associated with treatment differences accounted for only 0.81% of the 12.9% survival difference.

Conclusions and Relevance: In the SEER-Medicare database, differences in breast cancer survival between black and white women did not substantially change among women diagnosed between 1991 and 2005. These differences in survival appear primarily related to presentation characteristics at diagnosis rather than treatment differences.


JAMA : The Journal of the American Medical Association

Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer

JAMA 2013 Jul 24;310(4)389-397, JH Silber, PR Rosenbaum, AS Clark, BJ Giantonio, RN Ross, Y Teng, M Wang, BA Niknam, JM Ludwig, W Wang, O Even-Shoshan, KR Fox