Study: Age, race, economics affect cancer treatment

Young poor, black and Hispanic women diagnosed with breast cancer tend to experience longer delays before undergoing treatment and have poorer survival as a direct consequence, researchers have found in a massive analysis of more than 8,000 cases.

A team of California researchers who searched a vast cancer registry found that adolescents and young women -- 15 to 39 -- were diagnosed later in the course of their disease -- and died sooner. Most, on average, were diagnosed at least six weeks later than their more affluent counterparts.

The findings are not only relative to California, but extend to poor and largely minority women across the country, including Long Island, said Dr. Barbara Ross-Lee, a medical policy expert and vice president of health sciences at NYIT College of Osteopathic Medicine in Old Westbury.

"We've been very slow in documenting these kinds of problems and even slower in crafting solutions," said Ross-Lee, who also heads a national institute on multicultural medicine and policy.

Breast cancer in young women is relatively rare, accounting for only 5 percent to 6 percent of cases, said Dr. Erlyn Smith of the University of California, Irvine, who led the cancer-registry study. The research was reported Wednesday in the online edition of Surgery, a publication of the American Medical Association.

Doctors have long known that breast cancer in premenopausal women is not only more aggressive, but also more likely to spread and, as a result, have a worse prognosis.

Black and Hispanic women accounted for nearly 31 percent of women in the study who delayed breast cancer treatment. Smith found that uninsured women and those with public-financed health insurance were more likely to delay treatment, compared with women who had private health insurance.

Dr. Aloysius Cuyjet, a Garden City physician and former director of a health disparities institute at Nassau University Medical Center, said economics plays a key role in who is treated -- and who is not.

"It has been known for some time black women have a higher mortality from breast cancer primarily because of late diagnosis. And now I see with this study, the same is true for Hispanic women. Economics are always a contributing factor to disparities. If you are of limited income and have to allocate a small amount of money to food, rent, mortgage, bills -- usually health care is not at the top of the list," he said.

But Ross-Lee said there are problems in the medical community regarding Medicaid and other forms of public health insurance. Fewer doctors are accepting Medicaid patients, an obstacle that makes accessing care more difficult, she said.

"In this country, it is against the law to discriminate against people based on race, ethnicity or sexual orientation. But there is a very open form of discrimination based on economic status, and Medicaid is perceived as a clear marker for socioeconomic status," she said.

A study earlier this year conducted by researchers at Massachusetts General Hospital found nearly 30 percent of more than 800 primary care physicians responding to a national survey said they would not accept Medicaid or uninsured patients.