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Poverty, Not Race, Is Cancer Factor

Poor women with breast cancer are three times more likely to die of the disease than are other patients, according to a study that found it was poverty, not race, that determined the outcome of their medical care.

In a report appearing Wednesday in the Journal of the National Cancer Institute, researchers said other studies have shown that black women are more likely to be diagnosed with late stage breast cancer and to have a shorter survival time than white women. It has not been clear if this is because of race or poverty.

In a new study, Cathy J. Bradley of Michigan State University and her co-authors show that the answer is poverty. They found that a lower socio-economic status is more important than race in determining the medical care for women with breast cancer.

"Poor persons, regardless of their race, are likely to have undesirable cancer outcomes," the study found.

Bradley said that the researchers used the Detroit cancer registry to identify 5,719 women with breast cancer. They then searched the registry for women with breast cancer who were also listed on the rolls of Medicaid, a program that provides medical care to the poor. They found 593 breast cancer patients in Medicaid and with incomes below the federal poverty level.

The researchers then compared the medical outcome of the patients on Medicaid with those who were not. In effect, Medicaid enrollment was used as a surrogate for poverty.

Bradley said they found that women on Medicaid were 41 percent more likely to be diagnosed with breast cancer at a late stage and were 44 percent less likely to receive radiation, a key part of breast cancer therapy. Women on Medicaid were also three times more likely to die of the disease than were non-Medicaid patients.

The poor outcome of the Medicaid patients suggests that they are not receiving the routine medical care that might cause breast cancer to be discovered at an earlier, more treatable stage, said Bradley.

"If you don't have a regular source of care prior to that diagnosis, you are more likely to be at a late stage of the disease" when treatment starts, said Bradley. This suggests, she said, "there are gaps in the coverage."

She said there is a need for some initiative "that could reduce this late stage diagnosis and to provide care."

Dr. Otis Brawley of the Winship Cancer Institute of Emory University said in a journal editorial that finding the true reasons for the difference in medical outcome is important "if we are to effectively reduce it."

"Rather than speaking in racial/ethnic terms of black and white populations, it is more appropriate to speak in socio-economic terms of the 'haves' and the 'have nots,'" said Brawley. "This focus would rightfully bring other socio-economically deprived populations that include whites, Hispanics, Native Americans and Asians into the discussion."

By Paul Recer