An interdisciplinary team led by Columbia University Medical Center received a $10 million grant from the Department of Defense to assess why breast cancer remains under-treated among black women and to better understand the disparities in survival rates.
Despite the substantially improved survival rates of women who receive adjuvant therapy following surgery, studies have shown that 30 percent or more of breast cancer patients fail to receive complete treatment, and that black women are as much as 10 percent less likely than white women to receive the optimal recommended doses.
"Identifying the barriers to optimal treatment will enable us to intervene to reduce racial disparities and to improve survival for all women with breast cancer," said Alfred I. Neugut, professor of medicine and epidemiology at CUMC, co-director of the Cancer Prevention Program at New York-Presbyterian Hospital/Columbia, and principal investigator of the DOD-funded Breast Cancer Center of Excellence.
The center will examine possible reasons for the disparity, including a lack of referrals to medical oncologists, miscommunication between patients and physicians, economic and cultural differences between patients and physicians, physical tolerance of therapy, and variations in the metabolism of chemotherapy.
"Little is known about the reasons for this failure, but we believe the causes of this racial disparity are potentially modifiable," said Dawn Hershman, assistant professor of medicine and epidemiology at Columbia's Mailman School of Public Health, director of the Clinical Breast Oncology program at NYPH/Columbia and co-principal investigator of the center.
The center will be a collaboration of experts from Columbia University College of Physicians & Surgeons, the Mailman School of Public Health and New York-Presbyterian Hospital, among other institutions. Housed at NYPH/Columbia, the center will bring together experts in medical and surgical oncology, epidemiology, biostatistics, behavioral oncology, communications research, consumer advocates, health outcomes research and molecular genetics to address these issues.
Breast Cancer Center of Excellence will study 900 black and 900 white breast cancer patients from two already-funded studies. One is a study of etiologic factors for breast cancer in black and white women at eight hospitals in New York City under the direction of Dana Bovbjerg of Mt. Sinai and Christine Ambrosone of Roswell Park Cancer Center. The second study, headed by Larry Kushi of Kaiser Permanente in California, is funded by the National Cancer Institute to assess the impact of lifestyle risk factors on breast cancer survival outcomes.
The center will conduct interviews with the 1,800 women to collect information on referrals to oncologists, recommended therapy, psychological status, cultural and personal values, and preferences and perceptions of physician-patient interaction. Researchers will ascertain patients' adherence to the recommended chemotherapy, dose-intensity and toxicities, and collect clinical information and blood specimens. The oncologists treating the patients will be surveyed about their attitudes toward treatment. And patient medical records will be reviewed to gather data on incomplete treatment and the reasons for it.