Many Black Women Refuse Breast Cancer Treatments
FRIDAY May 22, 2009 -- Almost 25 percent of black women with advanced breast cancer refuse the chemotherapy and radiation treatments that could save their lives, a new study finds.
Black women have almost twice the rate of advanced breast cancer as white women do, largely because the disease is often diagnosed after it has already progressed. In addition, some black women have misconceptions about cancer and are reluctant to seek medical help, the researchers said.
"We found in this study on locally advanced breast cancer, mainly done in black women, that almost a quarter of the patients [refused] chemotherapy and radiation therapy that are the standard of care for stage 3 breast cancer," said lead researcher Dr. Monica Rizzo, an assistant professor of surgery in the Division of Surgical Oncology at Emory University School of Medicine in Atlanta.
Why these women balk at treatment is unclear, Rizzo said. "We looked at martial status, as well as religious background, of those women and, unfortunately, we were not able to find any clear identifier," she said.
Things that may be associated with their refusal of treatment are fear of the medical system and poverty, which makes it difficult to get to the hospital and get time off work for treatment, Rizzo said. In addition, cultural differences may also play a role, she said.
Rizzo noted many more blacks refuse breast cancer treatment than women from other populations.
The report is published in the May 22 online edition of Cancer.
For the study, Rizzo's team looked at the records of 107 women with advanced breast cancer reported in one inner city hospital from 2000 to 2006. About 87 percent of these women were black. Among these women, 29 percent had tumors that do not respond well to new targeted treatments.
Although the recommend treatments for advanced breast cancer are chemotherapy and radiation, many women chose not to be treated. In fact, 20.5 percent refused chemotherapy, and 26.3 percent refused radiation, the researchers reported.
The researchers speculated that factors such as cultural beliefs, access to health care, other illnesses and patient choice may all play a role.
To try to get more of these women to accept treatment, Rizzo's group has started a community outreach program that uses a nurse practitioner and a social worker to follow breast cancer patients and their care.
Educating women is also important, Rizzo said. "Educate more women and dispel some fears that they can have about cancer and cancer treatment, and encourage them to have yearly mammograms to catch cancers at an earlier stage, when the cancer is more curable," she said.
Breast cancer expert Dr. Gretchen G. Kimmick, an associate professor of oncology at Duke University Medical Center, thinks these results are concerning.
"This finding, that a large proportion of these women were not getting chemotherapy or radiation, is worrisome," Kimmick said.
"I think it's a social and cultural thing," Kimmick said. "We have to educate and be sensitive to cultural issues, too. Some of the women we take care of think God is going to take care of them, so they don't pursue their treatment," she said. "Sometimes that's how they deal with crisis."
Kimmick thinks poverty has an influence as well. "Lower-income patients don't have the job security that some other people have. If they are absent form their job for days in a row, they're going to lose their job," she said. "They are also embarrassed they can't pay."
More needs to be done to remove these disparities, Kimmick said. "Disparities are not just fixed by telling people what they need to do -- you have to help them do it," she said.
Barbara A. Brenner, executive director of Breast Cancer Action, said the study does not add much to what is already known.
"I find the study curious at best," Brenner said. "There seems to be very little new in it. The researchers seem to have worked around the edges of the most important questions for black women with stage 3 breast cancer -- the need for better and more effective treatments, and the need to understand how failure to complete treatment, which is an issue that reaches far beyond the black community, affects outcomes," she said.
Posted: May 2009
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