Disparities in breast cancer treatment exist even among fully insured African-Amerian women and white women in Georgia, according to a study released Sunday by WellPoint, parent company of Blue Cross and Blue Shield of Georgia.
The study, presented Sunday at the annual meeting of the American Society of Clinical Oncology in Chicago, was based on an analysis of administrative claims data and medical charts for more than 3,000 Blue Cross and Blue Shield of Georgia members, who were diagnosed with breast cancer between January 2000 and August 2005.
Dr. Otis Brawley, chief medical officer of the American Cancer Society and a professor at the Emory University School of Medicine, said health insurance companies like Blue Cross and Blue Shield of Georgia are paying out much more for the treatment of black women than white women with breast cancer.
But the study shows that money is not the reason for the disparities, said Brawley, co-author of the study.
"We have been looking at why the disparities exist for a long time," he said. "We thought it was due to lack of insurance, in part. This study indicates that people who have low stage breast cancer, who are black, are less likely to get it treated effectively than those who are white."
He said he was somewhat perplexed, but concluded that "we are still not providing adequate care to a subset of the population, even if they have health insurance. A higher proportion of whites get quality care, compared with blacks who get adequate care. This is a question for society: Why? You just can't say it's lack of insurance."
The study said "it is common knowledge there are disparities in breast cancer diagnosis and treatment as it relates to the population as a whole, but the idea that disparities exist even in an insured population is not as intuitive."
Dr. Louise Short, lead investigator for the study, said "steps can be taken to reduce these differences among the fully insured population."
While previous research has shown a relationship between African-American women having an increased breast cancer risk and mortality, the study attempted to determine factors leading to these rates.
Study researchers found that factors predicting worse outcomes for African-American women compared to white women with newly diagnosed breast cancer in a fully insured population included: diagnosis at a younger age and later stage, a lower prevalence of hormone positive disease, lower rates of hormone therapy for certain types of patients and higher prevalence of hypertension.
According to an explanation provided by WellPoint, the findings "indicate that culturally sensitive and targeted interventions must be developed to increase earlier detection of breast cancer in African-Americans, increase the percentage of patients that receive hormonal therapy when it is indicated, and include management of co-morbid conditions."
Dr. Sandra White, medical director for Blue Cross and Blue Shield of Georgia, said approaches are being developed to raise awareness of the importance of earlier detection of breast cancer and treatment options for the disease among African-American women in Georgia.
Aside from nonmelanoma skin cancer, breast cancer is the most common form of cancer in women, according to the U.S. Centers for Disease Control and Prevention in Atlanta.
Breast cancer is the No. 1 cause of cancer death in Hispanic women and the second most common cause of cancer death in Caucasian, African-American, Asian-Pacific Islander and American Indian/Alaska Native women.
Brawley said black women with cancer are likely to run up higher bills than white women because they get diagnosed later and are treated longer.
"If we can make the system more efficient, we can decrease the amount of care and decrease the suffering," he said in an interview. "I don't think this is a problem only in Georgia, but anywhere you go in the United States."
He said many black women "may not trust the system" as much as whites.
"The death rate for black women from breast cancer was the same up through 1981," he said. "Every year, the death rate has gotten more divergent. The difference for black women and white women in 2005 was greater than it was in 1995, and it is greater in '95 than it was in 1985."
The study was done by HealthCore, a research subsidiary of WellPoint.
Brawley said the study was the first "to examine the care received by a fully-insured population, and our data shows that while health insurance is an important predictor of the quality of care an individual receives, it's not the only factor.
"African-American women with insurance often do not receive the same level of care as their Caucasian counterparts, and we must work to improve care and outcomes among this population," Brawley said.
Copyright 2008 The Atlanta Journal-Constitution
