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NLM Director’s Comments Transcript
Breast Cancer Survival: Differences between Black and White Women – 09/16/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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White women (age 65 and older) who have breast cancer live about three years longer than black women with breast cancer within the same age range, finds a national study with an accompanying editorial recently published in the Journal of the American Medical Association.

The study’s findings, based on about 107,000 breast cancer cases between 1991-2005, found 56 percent of black women (age 65 and older) were alive five years after a breast cancer diagnosis compared to 70 percent of white women, who were in the same age range. The findings also suggest the overall, statistically significant differences in breast cancer five year survival rates (comparing white to black women) was consistent (or gaps did not close) during the 14+ year time period the researchers assessed.  

On the other hand, the study’s findings (based on a national assessment of female Medicare beneficiaries) suggest breast cancer survival dissimilarities occur primarily because black women tend to access breast cancer treatment (or enter care) in poorer health and receive treatment later than white women age 65 and older. Among several examples, the study found three months after a breast cancer diagnosis about six percent of black women did not start treatment compared to 2.5 percent of white women with the same tumors. The study found about 20 percent of black female breast cancer patients received an initial breast cancer diagnosis when the disease was at stage III or IV (considered an advanced stage) compared to about 11 percent of white patients.

The study’s 12 authors add while there were differences in several breast cancer treatment areas, including a comparative lower use of some anti-cancer medications for black women, the overall treatment differences did not statistically account for most of the gaps in the survival rate.

Alternatively, the authors note (and we quote): ‘most of the difference is explained by poorer health of black patients at diagnosis, with more advanced disease, worse biological features of the disease, and more comorbid conditions’ (end of quote).

An accompanying editorial explains the study’s findings are more robust than previous research because a large number of white breast cancer cases provided a sample that yielded a well-matched control with survival statistics among senior black women. The study’s methods also updated some of the breast cancers diagnosed in 2004 and 2005 with a minimum four year follow up to better determine post-diagnosis survival.

The study’s findings are derived from Medicare data called the Surveillance, Epidemiology and End Results, or SEER, that is widely used in observational clinical research. While SEER is sponsored by the National Cancer Institute, the current study was funded by the Agency for Healthcare Research and Quality — both are within the U.S. Department of Health and Human Services.

The accompanying editorial adds the study also raises issues for further exploration including the need to more comprehensively discern the extent breast cancer survival rates are impacted by poorer health (that reflect health disparities) compared to differences in clinical treatment. For example, the editorial’s authors note the current research did not assess some treatment procedures, such as the quality of hormone therapy treatment for breast cancer patients. The editorial’s authors note this addition (as well as others) in future research (and we quote) ‘will be critical to understanding the true contribution of breast cancer treatment to population level race disparities in outcome’ (end of quote).

Meanwhile, MedlinePlus.gov’s breast cancer health topic page provides comprehensive information about breast cancer’s  diagnosis/symptoms, prevention/screening, and treatment.

The U.S. Centers for Disease Controls and Prevention provides a breakdown of breast cancer rates by race and ethnicity within the ‘statistics’ section of MedlinePlus.gov’s breast cancer  health topic page.

A helpful website (from the National Institute on Aging) that provides a variety of easy-to-read information about breast cancer (for seniors) is available in the ‘seniors’ section of MedlinePlus.gov’s breast cancer health topic page.

MedlinePlus.gov’s breast cancer health topic page also contains research summaries, which are available in the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about breast cancer as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s breast cancer health topic page, type ‘breast cancer’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘breast cancer (National Library of Medicine).’ MedlinePlus.gov additionally features health topic pages on breast diseases and health disparities.   

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