Understanding the racial gap in breast ca survival

Black women with breast cancer do not live as long as white women with breast cancer, largely because of a higher rate of competing illnesses or "comorbidities," according to a study in this week's issue of the Journal of the American Medical Association.

In the study, comorbid illness explained roughly half of the overall survival disparity between black and white women and the majority of the competing-causes survival disparity.

"Diabetes and hypertension are the two most important comorbidities accounting for survival disparities" among black and white women, study chief Dr. C. Martin Tammemagi from Brock University, St. Catharines, Ontario told.

Effective control of these and other comorbid conditions in black breast cancer patients "should help improve their life expectancy and reduce survival disparities," the researcher said.

Overall, breast cancer survival rates have improved in the last three decades. However, disparities in breast cancer survival between blacks and whites have not declined and remain sizable. Advanced cancer stage, lack of access to medical care, inferior treatment, and lower socioeconomic status likely explain some, but not all, of this disparity.

Tammemagi's team evaluated the role of comorbid illness and racial survival disparity in a cohort of 906 breast cancer patients who were followed for a median of 10 years. Two hundred sixty-four of the women were black (29 percent) and 642 were white (71 percent).

Breast cancer is a malignant growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer.

There are several different types of breast cancer. Ductal carcinoma begins in the cells lining the ducts that bring milk to the nipple and accounts for more than 75% of breast cancers.

Lobular carcinoma begins in the milk-secreting glands of the breast but is otherwise fairly similar in its behavior to ductal carcinoma. Other varieties of breast cancer can arise from the skin, fat, connective tissues, and other cells present in the breast.
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A total of 159 black women (62 percent) and 317 white women (50 percent) died during follow-up.

Black breast cancer patients had more cancer recurrence and more progression of their cancer and worse overall survival and breast-cancer specific survival.

According to the team, most black and white patients died of causes unrelated to their cancer. Thirty-seven percent of black women died of an illness other than breast cancer while 25 percent died of . The corresponding figures for white women were 32 percent and 18 percent.