Chemotherapy can be a crucial element of breast cancer treatment. It’s essential to complete the entire recommended regimen of chemotherapy to prevent recurrences and possibly lengthen survival after treatment. New research suggests that non-white women are less likely to complete the full-term course of chemotherapy to treat their breast cancer. What gives?
Researchers enlisted 124 women with a diagnosis of breast cancer who were taking neoadjuvant chemotherapy. This is chemotherapy that is recommended to patients with large tumors or “heavy tumor load” prior to surgery, in order to shrink the tumors and perhaps allow for less extensive surgery. Ideally, the therapy would reduce the tumors enough for doctors could perform a lumpectomy or other breast-conserving surgery rather than a complete mastectomy. Out of the group, 92 subjects (74 percent) completed their full neoadjuvant regimen.
After accounting for data including age, insurance coverage, and tumor size, which all can affect a patient’s chemotherapy completion, the researchers noted that white women were more than three times more likely to finish this type of neoadjuvant therapy than black, Hispanic, and Asian women. The senior researcher acknowledged that diagnosis, treatment, and survival rates among breast cancer patients differ according to race. Access to health care, likelihood of insurance coverage, frequency of screening, aggressiveness of treatment, and ability to seek and/or follow up with medical care are all variables among women of different races.
In this study there was no clear explanation for why white women were more likely to complete neoadjuvant chemotherapy. Experts noted that toxicity to the chemotherapy — meaning, side effects that made it hard to tolerate the treatment to its completion — seemed to be the major explanation. The most common complaints were neurological problems or pain for women of color and gastrointestinal complaints for white women. Some of the women stopped treatment because the disease was progressing despite the chemo, psychological reasons, social issues, or personal beliefs (for instance, “the chemotherapy, not the disease, is killing me.”)
It’s important to note that there was no significant difference among the kinds of neoadjuvant therapies prescribed to the patients. As it turned out, the neoadjuvant therapy did not help many patients to qualify for less extensive surgery. Nor did a secondary goal, pathologic complete response (pCR), seem to depend on whether the women finished their neoadjuvant chemotherapy. A pCR is when no tumor remains after neoadjuvant therapy, which is linked to better survival odds.
The researchers also noted that non-white participants had larger tumors before the chemotherapy; it’s possible their cancers tended to be more advanced when diagnosed, or that they waited longer before treatment. The non-white patients were also more likely in this study to have government health plans like Medicaid, but that did not appear to affect outcomes.
There are some variables to consider about this study. It was a small study that included only 38 non-white patients, and it appears that most of the patients who stopped chemotherapy did so because of chemotherapy toxicity issues. In the end, finishing adjuvant therapy did not seem to reduce the extent of breast surgery required, or cause tumors to disappear.
Still, completing neoadjuvant therapy is an important objective treating breast cancer. Some experts think this particular study shows that research should focus more intensely on finding more tolerable, less toxic chemotherapy regimens.
Identifying breast cancer in its earliest stage, engaging the patient in early treatment, and ensuring that the patient complies fully with the recommended treatment are important to helping the patient live longer and preventing recurrence of the cancer. So how do we level the playing field so that ALL women, regardless of race, have the best opportunities to fight and beat breast cancer?
Research shows that women of color (including blacks, Hispanics, Asians, Pacific Islanders, and American Indians) seem to have similar breast cancer survival rates whether or not they have insurance coverage. There are many factors influencing why these women don’t get the screening and care they need. They may still be unable to cover the indirect and direct costs of cancer care, defer their health needs in favor of the rest of the family, have low health literacy, lack correct information, or labor under long-held myths about the disease.
Health professionals and community leaders need to promote better outreach to all women with possible breast health issues, and direct breast cancer campaigns to underserved cultures and communities. This is also an opportunity to update approaches to sex education to acknowledge cultural influences that may affect women's health literacy, in order to provide directed breast health education at a younger age.
If you need support, counseling, financial services, or other help with a breast cancer diagnosis, you can reach out to a wide range of organizations. The Women’s Health and Cancer Act helps to protect your right to have reconstruction after mastectomy by requiring your insurance to cover those costs.
The single most important thing that’s within your power is to seek reliable health information from health professionals you trust, and family or friends who have experienced breast cancer challenges.