Nav: Home

African Americans half as likely to receive surgery for esophageal cancer

January 18, 2005

Alexandria, VA-- African Americans with esophageal cancer are half as likely as whites to be seen by a surgeon and to receive life-prolonging surgery, a new study shows. The study, which examined racial disparities in access to surgical evaluation, receipt of surgery, and survival among older patients with esophageal cancer, found that only 25% of African-American patients received potentially curative surgery, compared to 46% of white patients. The study will be published in the January 20 issue of the Journal of Clinical Oncology (JCO).

"Our study showed that black patients are less likely to be seen by a surgeon, and if seen, less likely to undergo surgery," said Ewout W. Steyerberg, PhD, Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands, and lead author of the study. "We were particularly surprised by the two-fold difference in rate of surgery, which may explain why African Americans experience a lower rate of survival."

Researchers reported that African Americans were generally undertreated for their disease. Twenty percent of African-American patients received radiotherapy as their only treatment and 26% received no therapy at all, compared to 13% and 15% of white patients, respectively.

Surgery is the most common form of treatment for esophageal cancer. Although the disease typically has a poor prognosis, almost 20% of patients with locoregional esophageal cancer survive at least five years after surgery. In 2004, approximately 14,250 new cases of esophageal cancer were diagnosed in the United States, and an estimated 13,300 people died of the disease. Esophageal cancer is nearly three times more common among men than women, and three times more prevalent among blacks than whites. The overall five-year relative survival rate of people with esophageal cancer is 14%.

Researchers at the Dana Farber Cancer Institute in Boston reviewed the Medicare records of 2,946 non-Hispanic white patients and 367 African-American patients from the SEER database with locoregional esophageal cancer ages 65 and older. Patients were classified by sex, age at diagnosis, geographic region, socioeconomic status, and pre-existing health conditions. In comparison to white patients, African-American patients were slightly younger, had a lower socioeconomic status, and had more pre-existing diseases, such as heart disease and diabetes. African-American patients were also more likely to have squamous cell cancer, which typically arises in the middle or upper part of the esophagus.

To better understand why blacks are less likely to undergo surgery, researchers examined the proportion of black and white patients ever assessed by a surgeon, and the rate of surgery among those receiving a surgical evaluation. They found that 70% of African-American patients were assessed by a surgeon, compared to 78% of white patients. Among the 258 African-American patients who received a surgical evaluation, only 35% underwent surgery, compared to 59% of 2,307 white patients. Researchers noted that age, socioeconomic status, and pre-existing health conditions only partly explained why black patients experienced a lower rate of surgical evaluation and surgery.

African Americans also exhibited poorer survival rates at every stage of follow-up compared to white patients. Two years after diagnosis, 18% of African Americans were still alive, compared to 25% for white patients. However, when African Americans received surgery, they experienced similar survival rates to white patients receiving surgery.

"African-American patients need equal opportunities to receive quality cancer care. The time has come for us to move beyond just trying to remove barriers to access to care and actually work to engage vulnerable patients and find ways to facilitate their participation in care," Dr. Steyerberg said.

Researchers added that they were limited by the observational nature of the study, noting that SEER data could not completely explain racial disparities in treatment, particularly the role of patient preference and physician bias.

"Racial Differences in Surgical Evaluation, Treatment, and Outcome of Locoregional Esophageal Cancer: A Population-based Analysis of Elderly Patients." Ewout W. Steyerberg, et al, Center for Clinical Decision Sciences, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
-end-
The Journal of Clinical Oncology is the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world's leading professional society representing physicians who treat people with cancer.

ATTRIBUTION TO THE JOURNAL OF CLINICAL ONCOLOGY IS REQUESTED IN ALL NEWS COVERAGE.

For the full text of any JCO article, contact 703-519-1422 or 212-584-5014.

The JCO News Digest is also distributed via e-mail. Please let us know if you would like to be added to our e-mail distribution list.

American Society of Clinical Oncology

Related Public Health Articles:

Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
Public health experts support federally mandated smoke-free public housing
In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities, three public health experts applaud the efforts of the US Department of Housing and Urban Development to protect nonsmoking residents from the harmful effects of tobacco exposure.
The Lancet Public Health: UK soft drinks industry levy estimated to have significant health benefits, especially among children
The UK soft drinks industry levy, due to be introduced in April 2018, is estimated to have significant health benefits, especially among children, according to the first study to estimate its health impact, published in The Lancet Public Health.
More Public Health News and Public Health Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#535 Superior
Apologies for the delay getting this week's episode out! A technical glitch slowed us down, but all is once again well. This week, we look at the often troubling intertwining of science and race: its long history, its ability to persist even during periods of disrepute, and the current forms it takes as it resurfaces, leveraging the internet and nationalism to buoy itself. We speak with Angela Saini, independent journalist and author of the new book "Superior: The Return of Race Science", about where race science went and how it's coming back.