(HealthDay News) — For patients with breast cancer, there are racial and ethnic differences in treatment declination, according to a study published online May 9 in JAMA Network Open.
Jincong Q. Freeman, M.P.H., from the University of Chicago, and colleagues examined trends and racial and ethnic disparities in treatment declination and overall survival using data from patients with breast cancer from 2004 to 2020. Four treatment modalities were assessed: chemotherapy, hormone therapy (HT), radiotherapy, and surgery.
Data were included from 2,837,446 patients. The researchers found that 9.6, 6.1, 5.0, and 0.6 percent of the 1,296,488, 1,635,916, 1,893,339, and 2,590,963 patients declined chemotherapy, radiotherapy, HT, and surgery, respectively. The likelihood of declining surgery was increased for American Indian, Alaska Native, or other patients, Asian or Pacific Islander patients, and Black patients compared with White patients (adjusted odds ratios, 1.47, 1.29, and 2.01, respectively. American Indian, Alaska Native, or other patients and Asian or Pacific Islander patients were more likely to decline chemotherapy (adjusted odds ratios, 1.13 and 1.21, respectively); and Black patients were more likely to decline radiotherapy (adjusted odds ratio, 1.05). The likelihood of declining HT was lower for Asian and Pacific Islander patients, Black patients, and Hispanic patients (adjusted odds ratios, 0.81, 0.86, and 0.66, respectively).
Higher mortality was seen for Black versus White patients who declined chemotherapy (adjusted hazard ratio, 1.07), while no overall survival differences were seen for Black and White patients who declined HT or radiotherapy.
“Our findings highlight racial and ethnic disparities in declination of treatment recommendations and overall survival, suggesting the need for equity-focused interventions,” the authors write.
Why do Black women decline breast cancer treatment?
Black women are more likely to decline or delay breast cancer treatment compared to other races in the United States. This complex issue stems from a combination of social, economic, and healthcare system factors.
One major barrier is financial toxicity. Breast cancer treatment can be incredibly expensive, even with insurance. Black women are more likely to live in poverty and have inadequate health insurance, making treatment a significant financial burden that can lead to difficult choices.
Another factor is distrust in the medical system. A history of medical racism has led many Black people to feel a lack of trust in doctors and the healthcare system as a whole. This can make it difficult to seek out preventive care, screenings, and treatment.
Social and logistical challenges also play a role. Black women are more likely to be single mothers or caregivers for family members, making it difficult to take time off work for appointments and treatment. Additionally, lack of access to childcare or transportation can further complicate treatment adherence.
Finally, some Black women may have concerns about the side effects of treatment or the potential impact on their bodies. Open and culturally sensitive communication with healthcare providers is crucial to address these concerns and ensure informed decision-making.
By addressing the underlying social determinants of health and building trust within the medical system, we can work towards improving access to quality care and reducing these disparities for Black women facing breast cancer.