More aggressive cancers noted in black women

September 28, 1994|By Newsday

Black women who get breast cancer are more than twice as likely to die from it as white women, but a new study confirms that poorer access to medical care isn't the only reason -- the cancers in black women are also more aggressive.

The study -- the most definitive effort so far to unravel the mystery of why blacks are less likely to get the disease but more likely to die from it -- confirmed that inadequate screening is the chief reason for their poor survival. Black women had more advanced disease at diagnosis and, therefore, a worse prognosis than whites, and study authors urged better access to and education about mammography.

"Reducing the survival disadvantage is most likely to be achieved through strategies aimed at early recognition of the disease," said the study published today in the Journal of the American Medical Association.

But that won't eliminate the discrepancy, the study showed: The disease also is more malignant among black women, who were more likely to have fast-growing, and therefore more deadly, tumors.

"If you screen black women the same way as white women, they'll still come out at higher stages of the disease, and therefore have poorer survival," said Dr. J. William Eley of Emory University in Atlanta, the principal author.

The study, part of a larger study begun in 1983 to unravel the reasons blacks have higher cancer death rates, could not determine why black women tended to have more aggressive breast tumors. But it found strong connections to some environmental or cultural factors -- such as obesity, which is more common among black women, or use of estrogen replacement therapy, which is more common among whites.

The question of whether socioeconomic factors alone -- affecting issues such as nutrition, access to medical care, education, quality of care -- account for the differences between black and white survival has been a hot one. Some studies have found differences in survival are directly related to income.

"We didn't find that," said Dr. Eley. "We think it's more likely that the kinds of exposures differ between the races. We know, for instance, that the hormonal milieu for a women who is very obese is different from one who is not." In the study, which included 1,130 women in Atlanta, New Orleans and San Francisco, black women tended to be significantly more overweight.

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