Breast Cancer Test Guidance Lacking

A significant proportion of California women – particularly African-Americans and Latinas – receive hazy or no actionable advice on how to proceed when they are diagnosed with early stage breast cancer, according to a new study led by UCLA researchers.

The sticking point is primarily over a molecular laboratory test to determine if their form of breast cancer is likely to return in the future, which can help tailor treatments such as chemotherapy regimens for the best outcomes.

According to the mail and online survey of 890 Californians who had been diagnosed with early stage breast cancer, 90% were aware that they took the blood-based test, which undertakes gene expression profiling of their tumor. According to the study, only 14% of patients asked about the test; more than 80% of physicians ordered it on their own.

However, 20% of the patients in the study were unaware of the results of that test. Some patients even underwent chemotherapy when their form of breast cancer meant that it would not garner any signicantly better outcomes than other forms of treatment.

The break is particularly profound with Latinas and African-Americans. Among the former, only 78% were aware that they may have undergone such a test. With African-American women, it rises to 85%. But 98% of Asian-American and 94% of white women were aware that they were tested.

Physicians were also far more likely to discuss test results with Asian-American and white patients, with discussions occurring with those patients 98% and 97% of the time, respectively.

By comparison, such discussions ocurred with less than 91% of Latinas and 94% of African-Amerian patients.

Income disparities appeared to play little role at all, as 60% of the survey respondents lived in households with incomes above $75,000.

And while 7% of all women who tested for breast cancer that had a low risk for recurrence underwent chemotherapy, 15% of Latinas underwent such treatment, which can have adverse side effects such as extreme nausea and the loss of hair. About 7% of white patients underwent chemotherapy as well, but only about 2% of Asian-American women do.

“No one should have to go through the stress and discomfort of chemo without understanding the personal risks and benefits,” said Ninez Ponce, associate director of the UCLA Center for Health Policy and Research and the senior author of the study. “At the very least, patients should know their options.  Right now, some women may be making treatment decisions based on incomplete information.”

Although breast cancer is highly curable in its early stages and the long-term survival rates exceed 90%, that one in eight women will be diagnosed with the disease during their lifetimes suggest that communications between their providers be as open and proactive as possible.

Such testing and information disparities are quite common along ethnic lines. Ponce believes that some minority groups are not being empowered enough to ask about such information. She suggested that a customized educational campaign may be key to eliminating those disparities.

According to Ponce, UCLA researchers will be examining the effectiveness of such campaigns in a study whose results are expected to be published later this year.