In the United States, African American women have almost twice the rate of advanced (stage III) breast cancer than white women. To get a better sense of the tumor characteristics and medical care of these patients, researchers led by Monica Rizzo, M.D., of the Emory University School of Medicine and Emory University's Avon Comprehensive Breast Cancer Center at Grady reviewed stage III breast cancer data from 2000 to 2006 from an inner city hospital in Atlanta that serves a large African American population.
The investigators identified 107 cases of stage III breast cancers diagnosed and/or treated at this hospital over the six years of study. Approximately 87 percent of these cases were in African American women. Triple negative tumors accounted for 29 percent of the cases. These cancers do not express the estrogen receptor, the progesterone receptor or the human epidermal growth factor receptor 2 (HER2) and therefore do not respond well to therapies that target these proteins (such as trastuzumab, or Herceptin, which blocks HER2).
Chemotherapy and radiation are recommended therapies for patients with stage III breast cancer; however many women in this study decided to forego these treatments. The study found 20.5 percent of patients with stage III breast cancer refused chemotherapy, and 26.3 percent who should have received chest radiation refused. There was no difference in marital status, religious background, or age of the patients who refused either chemotherapy or radiation compared with the patients who received recommended care.
The authors say the reasons why African American women with advanced breast cancer often refuse necessary care are unclear. They could include socioeconomic and demographic factors, cultural beliefs, healthcare access, additional illnesses, and patient choice. Additional studies are needed to better define which factors play a role.
To dispel fears of cancer treatment and encourage compliance with recommended therapies, the study investigators have implemented a community outreach program at their institution. The program includes a nurse practitioner and a social worker who carefully follow all patients during and after their cancer treatments. "The high rate of refusal for important life saving therapies that we identified needs further study after implementation of our planned initiatives, so all women are offered and will receive appropriate care based on stage of diagnosis," the authors wrote.