2008 Woodie Awards
Black Americans undertreated for esophageal cancer
Janice Billingsley
Associated Press
Issue date: 1/26/05 Section: Lifestyles and Health
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The prognosis for esophageal cancer is poor, with less than 10 percent of patients surviving beyond five years. But surgery to remove the cancer enables approximately 20 percent of patients to survive beyond that time.
"If black patients undergo surgery, their survival is similar to that of white patients undergoing surgery. Yet we found that there was a twofold difference in rate of surgery, and this difference may explain why African-Americans experience a lower rate of survival," said the study author Ewout W. Steyerberg, a Netherlands scientist.
Study co-author Dr. Craig C. Earle, of Boston's Dana-Farber Cancer Institute, added: "There seems to be a problem with access to care for black patients."
The study results appear in the Jan. 20 issue of the Journal of Clinical Oncology.
In the study of 2,946 white patients and 367 black patients with esophageal cancer, 25 percent of the whites were alive two years after diagnosis, compared to 18 percent of the blacks.
The authors suggested that black Americans could have less trust in doctors than white patients do, and that might make them more reluctant to undergo surgery.
However, they wrote, "our finding that survival differed little by race among those who underwent surgery supports the value of intervention to increase the use of surgery among black patients with esophageal cancer."
Stephanie Johnson, a Duke University psychologist who heads a program to reduce the health disparities that exist in the black community, said that historic mistrust of doctors means black Americans often hear a doctor's recommendation differently than a white patient does.
"There are cultural nuances that are included in the decisions that African-Americans make because of the mistrust they have of the medical community," she said. "Physicians often aren't aware of this -- they're just trying to do their jobs."
Steyerberg is a scientist at the Center for Clinical Decision Sciences at the Erasmus MC, University Medical Center in the Netherlands. For the study, he and his Dana-Farber colleagues reviewed Medicare records of esophageal cancer patients whose cancer had not spread. All the patients were at least 65 at the time of diagnosis, and the researchers controlled the study for age, sex, type of esophageal cancer, stage of the disease and other health problems.