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© 2005 Oxford University Press
CORRESPONDENCE |
RESPONSE: Re: Ethnicity and Breast Cancer: Factors Influencing Differences in Incidence and Outcome
Affiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Comprehensive Cancer Research Center, Seattle, WA (RP); Howard University Cancer Center, Washington, DC (LLA-C)
Correspondence to: Rowan T. Chlebowski, MD, PhD, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502 (e-mail: rchlebow{at}whi.org).
In her correspondence, Dr. Richardson questions our conclusion that the more common development of poor prognosis cancers in African American women is a major factor in the increased breast cancer mortality seen (1). She suggests that we did not fully consider potential differences in health care access in our analysis and presents a thesis largely dependent on her statement that "there is no reason to believe that breast cancers in black women respond differently to cancer therapy than those in white women."
Although racial/ethnic differences in access and quality of health care undoubtedly exist, such differences were minimized in our Women's Health Initiative (WHI) population, which consisted of volunteers who came forward to participate in studies that would be unlikely to provide them with direct benefits. As a result, educational level was fairly comparable across the racial/ethnic groups in our study, with 78% of white and 73% of African American participants reporting at least some school after high school. Moreover, 96% of white and 94% of African American participants had ever had a mammogram before entry. The studies cited by Dr. Richardson contain greater discrepancies in socioeconomic characteristics across racial/ethnic groups than are seen in the WHI population.
In our original article, we identified three studies in which African American and white women were provided with similar breast cancer therapies and access but clinical outcome among African American women was poorer. Lower survival among African American women with breast cancer, as compared with white women, has been reported among women treated in the U.S. Department of Defense Healthcare System (2), in managed care populations (3), and in a multicenter clinical trial group setting in which identical adjuvant chemotherapy was administered (4). Such observations support the hypothesis that breast cancer outcome is worse in African American women even when access to and quality of healthcare are similar. Our finding that African American women were at a nearly fivefold increased risk of developing breast cancers with poor prognostic features provides a reasonable explanation for their less favorable outcome.
We agree with Dr. Richardson that efforts to improve access to and quality of health care in all underserved populations are a priority and must continue. However, attention should also be directed at biologic factors that may influence breast cancer outcome.
REFERENCES
(1) Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 2005;97:439–48.
(2) Jatoi I, Becher H, Leake CR. Widening disparity in survival between white and African American patients with breast carcinoma treated in U.S. Department of Defense Healthcare System. Cancer 2003;98:894–9.[CrossRef][ISI][Medline]
(3) Yood MU, Johnson CC, Blount A, Abrams J, Wolman E, McCarthy BD, et al. Race and differences in breast cancer survival in managed care population. J Natl Cancer Inst 1999;91:1487–91.
(4) Albain KS, Unger JM, Hutchins LF, Rivkin SE, Martino S, Livingston RB, et al. Outcome of African Americans on Southwest Oncology Group (SWOG) breast cancer adjuvant therapy trials. Breast Cancer Res Treat 2003;77:21 (abstract).
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J Natl Cancer Inst 2005 97: 1619.
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