Scientists at the Science of Cancer Health Disparities conference came together in Atlanta, Georgia, USA, this week to address the question, how do social disadvantages, genetics, race and culture contribute to the health disparities observed in many groups of men and women, as for example, in breast cancer treatment?
One of the studies presented was by co-researcher, Jane T. Pham, an epidemiologist at the Northern California Cancer Center (NCCC), Fremont, California, and doctoral candidate in epidemiology at the University of California, Davis, and was titled “Physician perspectives on surgical treatment disparities among Asian women with early stage breast cancer” (Abstract no A-54).
We know that breast cancer is a disease with a range of risk factors, including genetic and behavioural, but over the years researchers have observed these risks are often complicated by social and racial differences.
In the investigation that Pham and colleagues carried out, it appeared that Asian patients tended to have the attitude that the breast did not need to be preserved. The Asian culture seems not to emphasize the breast and its appearance, and this is believed to be an important factor in many Asian women choosing to have a mastectomy rather than a lumpectomy, was the view of the majority of doctors who took part in a survey.
The researchers said that the oncologists who treated Asian women with early stage breast cancer, got the impression they were mostly influenced by cultural factors when they made the decision to have a mastectomy rather than a lumpectomy, even though the latter might give them a better quality of life.
Another reason why Asian women choose mastectomy over lumpectomy that was given by the doctors who treated them was that because breast size in this group tended to be smaller to begin with, there was less breast to preserve. Other factors such as age, and not being prepared to travel for chemotherapy and radiotherapy, which often follow a lumpectomy, were also mentioned.
These reasons matter, said Pham and colleagues, because in order for the patient to make the best clinical decision, she must be completely aware of the benefits and risks of each option available, as Pham explained:
“For patients with early stage breast cancer where there are no clear clinical contraindications to breast-conserving treatment, a lumpectomy is less invasive than a mastectomy and it offers the same survival and potentially improved quality of life.”
A previous study had revealed that a statistically significant 67.5 per cent of Asian women chose mastectomy over lumpectomy compared to 57.3 Caucasian women. The proportion of women choosing the mastectomy option has been falling among most groups for the last ten years, said Pham, but much more slowly in the case of Asian women, she added.
In this latest study, Pham and colleagues used the Greater Bay Area Cancer Registry in California to locate and survey 80 doctors who treated Chinese, Vietnamese and Filipina breast cancer patients in the area. The questions included one that asked the physicians why they thought Asian women were opting for mastectomy to a more significant extent than other women.
The results showed that while 74 per cent of the survey respondents said that cosmetic considerations were usually important to women who opted for lumpectomy, most of them felt cultural factors, for instance the reduced emphasis on breast preservation, were the main reasons Asian women had mastectomies.
Among other reasons, the doctors also mentioned they believed fear, both of the possibility that the cancer could recur, and of the radiation and chemotherapy treatments, was a contributing factor.
Pham suggested that the next step is to investigate these points further with Asian patients themselves, and she mentioned the study is continuing to pursue this avenue, and was being funded by grants from the California Department of Health Services, National Cancer Institute and Centers for Disease Control and Prevention.
Pham put her finger on a significant question:
“Is it really a reduced significance of the breast when making treatment decisions, or is it fear about adverse outcomes?”
“Although many of these cultural factors require additional research, awareness of these factors can allow physicians to directly address Asian patient concerns that may be influenced by culture, and fully inform the patient of their treatment options,” she explained.
The conference was held in Atlanta, Georgia, US, from November 27th to 30th, by the American Association for Cancer Research (AACR) in conjunction with the Minorities in Cancer Research Council of the AACR, and co-sponsored by the National Cancer Institute (NCI) Center to Reduce Cancer Health Disparities.
Other studies presented at the conference include:
“Obesity and risk for relapse of breast cancer in women of low socioeconomic status”, Abstract no. A-34.
“Disparities in receipt of lymph node assessment among early stage female breast cancer patients”, Abstract no. A-65.
“Gene expression analysis of African-American and European-American breast tumors”, Abstract no. B-93.
Click here to read more about these studies (AACR press release).
Written by: Catharine Paddock