Neighborhood, Socioeconomic Status Among Factors Associated with Differential BC Treatment
A study of Asian American women with early-stage breast cancer in California found that while characteristics of a patient’s tumor strongly affect treatment options, neighborhood, socioeconomic status and even the type of hospital where treatment is provided frequently result in differential treatment and potentially less successful health outcomes.
The study, led by CPIC Research Scientist Scarlett Lin Gomez, Ph.D.
, M.P.H., looked at more than 20,000 Chinese, Japanese, Filipina, Korean, South Asian and Vietnamese women diagnosed with stage 0-II breast cancer between 1990 and 2007, who were eligible for breast-conserving surgery (BCS) with radiation (long considered a viable alternative treatment for mastectomy for most women with early-stage breast cancer, resulting in equivalent overall survival). Those six ethnic groups represent 91% of all Asian Americans ethnic groups with breast cancer.
“The results that we saw were consistent with our expectations based on similar studies and seem to be reflective of cultural and immigrant/language factors,” said Dr. Gomez.
The study showed that overall, 37.2% of Asian American women in the study received BCS with radiation, 49.7% received mastectomy, and 13.2% received the non-guideline treatment BCS without radiation.
Disturbingly, rates of BCS without radiation were found to be significantly more likely among Asian American women living in low socioeconomic status neighborhoods as well as ethnic enclave neighborhoods (those neighborhoods that are predominantly one ethnic group and that retain some cultural distinction from the surrounding community).
The study also found this significant difference for women diagnosed in smaller hospitals, hospitals serving predominantly low-income patients and hospitals with a higher percentage of Asian Americans patients.
The study found similar patterns for mastectomy among the groups studied.
“Asian Americans are among the most rapidly growing racial/ethnic populations in the country, and breast cancer is the most commonly diagnosed cancer among Asian American women,” Dr. Gomez said. “And while tumor characteristics are still the most important predictor when it comes to treatment, a woman’s race/ethnicity, nativity, and the types of hospitals that she is seen at, and neighborhood that she lives in seem to also be influencing treatments, which can result in differential health outcomes.
“Our hope is that the study ultimately translates into public health and patient-focused initiatives aimed at ensuring all women are fully informed about treatment options.”