Blacks in the U.S. with throat cancer are more likely than whites to have surgery that leaves them unable to speak than to get gentler voice-preserving treatments, a new study finds.
Previous research has found a similar racial disparity in breast cancer treatment, with blacks more often having the entire breast removed instead of just the cancerous lumps.
It’s unclear why the gap exists. But Dr. Allen Chen, who led the new study, said poverty, less education and deep-rooted historical biases could all be at work.
“There could be an underlying distrust among African Americans where they feel anything less than surgery might be considered quote-unquote experimental,” Chen, a radiation oncologist at University of California, Davis, told Reuters Health.
He referenced the Tuskegee experiment, conducted by the U.S. government into the 1970s, in which black patients with syphilis went untreated despite assurances to the contrary.
“That sort distrust needs to be addressed or alleviated,” Chen said, because voice-preserving treatment for throat cancer, based on radiation and drug therapy, is now the standard.
Laryngeal cancer is one of the most common head and neck cancers. In 2009, an estimated 12,290 adults (9,920 men and 2,370 women) in the United States will be diagnosed with laryngeal cancer. It is estimated that 3,660 deaths (2,900 men and 760 women) from this disease will occur this year.
Each year, an estimated 2,400 adults (1,900 men and 500 women) in the United States will be diagnosed with hypopharyngeal cancer.Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with laryngeal or hypopharyngeal cancer. Because statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2009.
His study, published in the Archives of Otolaryngology - Head & Neck Surgery, is based on data from a U.S. cancer registry including nearly 5,400 cases of laryngeal cancer between 1991 and 2008.
About 80 percent of whites had voice-preserving treatment, while the rest had their voice box surgically removed - the traditional approach.
Among blacks, 75 percent had the gentler therapy. While that’s only a five-percent difference, “I think it’s still a gap that needs to be narrowed,” Chen said.
Throat cancer is any kind of malignant tumor that is found within the confines of the larynx and the hypopharynx. Throat cancer is known to come in two forms laryngeal cancer and hypopharyngeal cancer. Throat cancer afflicts roughly 12,290 new people every year and kills approximately 3,990 people annually. Throat cancer used to be among the top twenty most common cancers in the United States. It is now less common due to the decreasing number of Americans that smoke. Similar trends are shown world wide. Excessive consumption of alcohol also increases the risk of throat cancer. Causes of Throat Cancer There is no known cause of throat cancer; however, major risk factors show an increased incidence of it among “at risk” segments of the population. Risk factors of throat cancer include the use of tobacco, excessive consumption of alcohol, human papilloma virus (which is a sexually transmitted disease), poor oral hygiene, environmental pollutions. The use of tobacco and alcohol together further increases this risk. Types of Throat Cancer There are two types of throat cancer based on the location of the cancer when it was found: laryngeal and hypolaryngeal. The larynx is the part of the throat that contains the vocal chords, in men, this part is commonly known as the Adam’s apple. The larynx is part of the respiratory system and protects the vocal chords. Cancers that begin here are called laryngeal cancers. The hypopharynx is the structure located at the beginning of the esophagus. It is part of the digestive system and it prevents food from going into the larynx and trachea. The hypolarynx facilitates the body’s swallowing mechanism. Cancers that begin at the hypopharynx are called hypopharyngeal cancers. Throat Cancer Symptoms Throat cancer symptoms include lingering sore throat, trouble or pain swallowing, a constantly recurring cough, sudden unexplained weight loss, a lump or mass in the neck, change in quality of the voice, hoarseness that lasts more than two weeks, or lingering ear pain.
The racial disparity remained after the researchers accounted for age, sex and how advanced patients’ tumors were, and it didn’t disappear in the more recent half of the study either. However, there was no significant gap between whites and Hispanics or Asians.
The study didn’t look at income or education, which might explain some of the difference. It’s also possible that more blacks lived in areas without access to the resources involved in voice-preserving therapy, which requires cooperation between doctors with different specialties.
While the gentler therapy might be just as effective as putting patients under the knife, surgery does have some advantages.
“It’s a one-stop deal,” said Chen, whereas it takes several weeks of treatment for drugs and radiation to work.
But if it’s a question of people believing treatment other than surgery is experimental, he added, “That perception needs to be changed.”
His team is now doing a follow-up study to try to rule out some potential explanations for the findings.
SOURCE: Archives of Otolaryngology - Head & Neck Surgery, July 16, 2012.
Racial Disparities in the Use of Voice Preservation Therapy for Locally Advanced Laryngeal Cancer
Conclusions Pronounced racial disparities exist in the use of larynx preservation therapy for locally advanced laryngeal cancer. While acknowledging the potential biases of socioeconomic factors, further research to better elucidate the underlying reasons for these findings may be warranted.
Approximately 12 000 cases of laryngeal cancer are diagnosed in the United States annually. Historically, the standard of care for patients with locally advanced laryngeal cancer consisted of total laryngectomy followed by adjuvant radiation therapy. However, the landmark Veteran Affairs (VA) Laryngeal Cancer Study in 1991 demonstrated that when compared with total laryngectomy followed by adjuvant radiation, the use of radiation therapy in patients who responded to induction chemotherapy conferred a high rate of larynx preservation without compromising survival. Subsequently, the Radiation Therapy Oncology Group (RTOG) trial 91-11 showed that concurrent chemoradiation is superior to induction chemotherapy, followed by radiation or radiation alone for larynx preservation. These studies, along with others, have resulted in the widespread acceptance of larynx preservation using radiation therapy with concurrent chemotherapy as the initial treatment for locally advanced laryngeal cancer, with total laryngectomy reserved for salvage therapy.
While nonsurgical larynx preservation appears to be gaining popularity among medical practitioners, it is unclear if racial disparities exist in its use. Since racial minorities often have worse access to care, particularly with respect to radiation therapy facilities and receive a lower quality of care, we hypothesized that black and Hispanic patients with locally advanced laryngeal cancers are less likely to undergo larynx preservation treatment than their white counterparts. To address this question, we identified patients with American Joint Committee on Cancer (AJCC) stage III and stage IV nonmetastatic laryngeal cancer from the Surveillance Epidemiology and End Results (SEER) database and analyzed trends in the use of larynx preservation.
Wei-Hsien Hou, MD, PhD; Megan E. Daly, MD; Nancy Y. Lee, MD; D. Gregory Farwell, MD; Quang Luu, MD; Allen M. Chen, MD