Survival in Three Cancers About 10% Better for Whites vs Blacks

Survival in Three Cancers About 10% Better for Whites vs Blacks

There are “large and persistent” racial differences in the 5-year disease-specific survival for ovarian, colon, and breast cancer in the United States, with whites having about a 10% higher survival rate than blacks, according to three new population-based studies published online December 5 in Cancer.

Led by researchers from the Centers for Disease Control and Prevention (CDC), the teams analyzed data from the CONCORD-2 study, which records the incidence and outcomes of 10 common cancers, including the three reported here, in 67 countries, including the United States.

For the United States, the large umbrella study uses individual patient records from 37 state registries, covering about 80% of the nation’s population.

In the new analyses, each team reported disease-specific survival for two periods: 2001-2003 and 2004-2009. Each team also concluded that broad public health efforts are needed to address the disparities.

In the breast cancer analysis, 5-year net survival for all US cases was “remarkably high” (88.2%), reported the authors, led by Jacqueline Miller, MD, from  the CDC’s Division of Cancer Prevention and Control.

However, when the numbers were parsed by race, there was an ongoing difference, despite some gains among black women.

Table 1. Breast Cancer 5-Year Net Survival

Time Period of Diagnosis	White (%)	Black (%)
2001-2003	89.1	76.9
2004-2009	86.6	78.4

 

“Black females are more likely than white females to experience delays in treatment and not to receive appropriate treatment for breast cancer,” comment the authors. They also observe that aggressive, triple-negative disease is more common among black women.

“The major point is that given advances in breast cancer treatment, racial disparities in breast cancer survival have not decreased over the past 2 decades. That means that black women are not receiving equal treatment when compared with white women,” Dr Miller told Medscape Medical News. 

Black women are not receiving equal treatment when compared with white women.
Dr Jacqueline Miller

If treatment were equal, “the gap in survival could be reduced substantially,” she added.

This new study of breast cancer is “excellent” and “adds to an abundance of existing papers that clearly demonstrate a disparity in breast cancer outcome based on ethnicity and socioeconomic factors,” said Quyen Chu, MD, director of surgical oncology at the Feist-Weiller Cancer Center in Shreveport, Louisiana, who was asked for comment.

But Dr Chu also called for action.

“What we need to do, as a society, is to move beyond proving that disparity exists and begin implementing policies that address such disparity,” he told Medscape Medical News in an email.

What we need to do, as a society, is to move beyond proving that disparity exists.
Dr Quyen Chu

“The million-dollar question is whether we have the mental fortitude and resolve to do this,” he asserted.

Public-private partnerships are necessary to “close the divide between the haves and have nots.” Without this kind of action, “we will be back here again in 10 years pointing out the obvious,” said Dr Chu. 

Colon and Ovarian Cancer Studies

In the colon cancer analysis, 5-year net survival increased slightly (0.9%) for all US cases over the time periods, reported the authors, led by Arica White, PhD, MPH, who is also from the CDC’s Division of Cancer Prevention and Control.

But, again, blacks fared less well than whites in each period.

Table 2. Colon Cancer 5-Year Net Survival

Time Period of Diagnosis	White (%)	Black (%)
2001-2003	64.5	54.7
2004-2009	65.4	56.6

 

Also, more blacks than whites were diagnosed at a distant stage in each time period (at a rate of about 5%).

“The disparities in survival likely reflect the differences in access to screening and receipt of high-quality health care,” Dr White told Medscape Medical News. These authors also observe that in general mortality related to colon and rectal cancer has been declining in the United States in recent decades, “likely because of screening.”

In the ovarian cancer analysis, the team found that more than half of all US cases were diagnosed at a distant stage.

Notably, for each time period, “black women had consistently worse survival compared to white women…despite similar stage distributions,” reported the authors, led by Sherri Stewart, PhD, from the CDC’s Division of Cancer Prevention and Control.

Black women had consistently worse survival compared to white women.
Dr Sherri Stewart

 Table 3. Ovarian Cancer 5-Year Net Survival

Time Period of Diagnosis	White (%)	Black (%)
2001-2003	40.1	29.6
2004-2009	41.7	31.1

“Current data demonstrate a large and persistent disparity in ovarian cancer survival among black women compared with white women in most states,” write the authors.

The team also notes that other studies have not revealed a survival difference between black and white women for ovarian cancer. However, they argue that those studies mostly had small sample sizes. Large studies are needed to detect differences because ovarian cancer is less common among blacks than whites, they say. The current study had nearly 14,000 cases among black women, “providing sufficient power for detecting racial differences.”

Specific and targeted education about symptoms among black women is needed, said Dr Stewart. “Ovarian cancer is not always a ‘silent killer,’ as it has often been labeled.  Ovarian cancer survival is considerably higher at early stages,” she told Medscape Medical News.

The studies were supported by the CDC. The authors of all three studies have disclosed no relevant financial relationships.

Cancer . Published online December 5, 2017. Breast cancer study, Colon cancer study, Ovarian cancer study

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc

 

Source link