New perspectives on health disparities in breast cancer research

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Breast cancer is a disease with a number of known genetic and behavioral risk factors, but scientists have seen that these risks are often compounded by social and racial inequalities. The question remains: how, exactly, do social disadvantages, genetics, race and culture add to the disparities faced by so many groups of women?

An Asian patient’s attitude that the breast doesn’t need to be preserved – primarily because of the culture’s reduced emphasis on the breast and breast appearance – is an important consideration that leads many Asian women to choose a mastectomy, said a majority of physicians who participated in the investigators’ survey.

Other reasons cited by physicians are that Asian women may choose a mastectomy because breast size in this population is smaller to begin with, so there is less breast to preserve, as well as factors such as age and unwillingness to travel for chemotherapy and radiation treatments which often are necessary following a lumpectomy.

Reasons for why Asian women choose mastectomy are important, say the NCCC team, because in order for a breast cancer patient to make the best clinical decision, she must be thoroughly educated on the benefits of each procedure. “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,” said Jane T. Pham, an epidemiologist at NCCC and doctoral candidate in epidemiology at University of California, Davis.

In earlier research, the investigators found that a statistically significant greater number of Asian women (67.5 percent) choose to have a mastectomy over lumpectomy compared to Caucasian women (57.3 percent). And while the use of mastectomy has fallen among most populations over the past decade, it has not fallen as fast among Asian women, Pham says.

Under the direction of lead investigator Scarlett Lin Gomez, Ph.D., research scientist at NCCC and associate director of the Greater Bay Area Cancer Registry, Pham and her colleagues surveyed 80 physicians in the region who treat Chinese, Vietnamese and Filipina breast cancer patients. The survey asked physicians why they felt Asian women were choosing mastectomy significantly more often than other women.

While 74 percent of physicians surveyed said that consideration of cosmetic result is usually important to women treated with lumpectomy, most of the physicians felt cultural factors, such as a reduced emphasis on breast preservation, are the primary reasons for the higher rate of mastectomies among Asian women. Physicians also listed fear, both of reoccurrence and of radiation and chemotherapy, as another contributing factor.

All of these findings need to be probed further with Asian patients themselves, and this study is currently ongoing, Pham says. Funding for these continuing studies was provided by grants through the California Department of Health Services, National Cancer Institute and Centers for Disease Control and Prevention.

“Is it really a reduced significance of the breast when making treatment decisions, or is it fear about adverse outcomes?” Pham asked. “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.”

Source: American Association for Cancer Research, USA

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