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    Research Grants Awarded

    Non-Clinical Factors in Disparate Treatment for Early Breast Cancer among Blacks and Whites

    Study Section:
    Population Specific

    Scientific Abstract:
    African American breast cancer patients have shorter survival compared to their White counterparts. This could be due to more advanced disease at presentation or lack of optimal treatment. The benefits of treatment appear to be similar between African Americans and Whites. However, evidence suggests that African Americans are less likely to receive optimal treatment. Definitive data on this and the reasons for the racial disparity in treatment is lacking. We propose to carry out a two-phase study in order to (1) test if racial differences exist in the treatment of early breast cancer, and (2) evaluate important factors at the patient, care process, and health system levels. In Phase I, we will conduct a 1:1 (African American to White) matched retrospective cohort study among patients with localized breast cancer. Early breast cancer patients diagnosed during the period between 1997 and 2003 will be identified from the New Jersey Cancer Registry. Subjects will be stratified into those residing in the northern, central and southern New Jersey . From each geographic location, 70 African Americans will be randomly selected (a total of 210 subjects). Within geographic locations, each African American patient will be matched with one White patient on cancer stage. Initial breast cancer treatment information will be obtained from the treating physicians of the 420 patients. We will then compare non-receipt of standard treatment between African Americans and Whites. In Phase II, we will conduct 4 focus groups with a total of 40 patients (10 from each racial group) who did not receive the standard treatment from the Northern and Southern geographic regions. We also will select 60 patients and pair them with their treating physicians to review their medical records and conduct depth interviews with patients and their treating physicians. Twenty subjects who received the standard treatment and 40 patients who did not receive the standard treatment, divided equally by race will be randomly chosen from the Northern, Central, and Southern regions of New Jersey . The purpose of Phase II is to evaluate the role of patient-level factors (from patient focus groups), health system-level factors (from patient depth interview), and care process-level factors (from physician depth interview) in explaining any racial differences in breast cancer treatment. The results of this study will help improve our understanding of the reasons for treatment disparities.

    Lay Abstract:
    Breast cancer is more common in Whites than in African Americans. However, African Americans tend to die earlier than Whites from breast cancer. This could be due to a more advanced disease at start of treatment or lack of treatment among African Americans. Although the benefits of treatment appear to be similar between Whites and African Americans, there is some evidence suggesting that African Americans tend not to receive the same treatment as Whites do. The extent of such treatment difference between the races and the reasons for the racial difference in treatment of breast cancer is not known. The purpose of the proposed study is to (i) investigate if African Americans receive less treatment than Whites for breast cancer at similar disease progression, and (ii) explore the reasons for the less frequent treatment among African Americans. We plan to conduct the proposed study in two Phases. In Phase I, all female patients will be identified from the New Jersey Cancer Registry. These patients will be grouped into those residing in northern, central and southern New Jersey . Within each geographic location, 70 African American breast cancer patients will be randomly selected. In each geographic location, each African American patient will be paired with one White patient with similar disease progression. We will then obtain each patient’s treatment history from their physicians and then compare how often African Americans and Whites received standard treatment. In Phase II, we will conduct group discussions with a total of 40 patients (10 from each race group) who did not receive the standard treatment from the Northern and Southern geographic regions. We also will select 60 patients and pair them with their treating physicians to review their medical records and conduct long interviews with patients and their treating physicians. Twenty subjects who received the standard treatment and 40 patients who did not receive the standard treatment, divided equally by race will be randomly chosen from the Northern, Central, and Southern regions of New Jersey . The aim of Phase II is to evaluate the role of important health care delivery and resource related factors in explaining any racial differences in breast cancer treatment. The results of this study will help plan interventions to minimize racial disparity in the treatment of breast cancer. It also will help to reduce the excess death borne by African American breast cancer patients.