A study reported in the April 3 issue of the Journal of the National Cancer Institute (JNCI, Vol. 94, No. 7: 490-496) said the kind of breast cancer treatment a woman receives is linked to her socioeconomic status.

This new report underscores findings from previous studies linking socioeconomic status with a later stage of breast cancer at diagnosis, less adequate treatment, and a worse prognosis, said Cathy J. Bradley, PhD, of Michigan State University in East Lansing.

An editorial in the same journal, authored by Otis Brawley, MD, a leading expert on minorities and cancer and associate director of Emory University's Winship Cancer Institute, said the study "demonstrates that socioeconomic factors that act largely through and are associated with race are responsible for much of the disparity between black and white women."

Brawley said, "In previous studies of cancer outcomes, it has been difficult to distinguish the effects of poverty from the effects of race."

Bradley's study linked data from the Detroit cancer registry with Michigan Medicaid enrollment. She and her colleagues found 5,719 women with breast cancer, and of those, 593 were insured by Medicaid. Medicaid was only available to people who had incomes below the poverty line. The rest of the women had other forms of insurance or were uninsured.

Bradley said that in her study, 13% of the white women lived in census tracts with a 13% or higher poverty level, whereas 84% of the African-American women lived in census tracts with a 13% or higher poverty level.

Results from the study showed that, compared with white women, African-American women were 53% more likely to be diagnosed with later-stage disease, 26% less likely to receive radiation after breast-conserving surgery, more than twice as likely to receive no surgery, and 39% more likely to die.

Women insured by Medicaid were 41% more likely to be diagnosed with late-stage breast cancer, 44% less likely to receive radiation after breast-conserving surgery, and three times more likely to die than women not insured by Medicaid.

Bradley said, "In our Metropolitan Detroit study population, race was not statistically significantly associated with unfavorable cancer outcomes. However, low socioeconomic status was associated with late-stage breast cancer at diagnosis, type of treatment received, and death.

"Poor persons, regardless of their race, are likely to have undesirable outcomes," Bradley said. "This finding should challenge the research and policy communities to provide remedies for reducing these disparities."

In the JNCI editorial, Brawley pointed out results of recent breast cancer trials show "that equal treatment yields equal outcomes among equal patients."

He said, "This study shows that whereas race is not important biologically, it is still very important in American society. It is a sad statement that race influences one's chances of obtaining adequate medical care. In the US, it is bad to have cancer; it is worse to be poor and have cancer; and it is even worse to be poor, black, and have cancer."

Brawley said, "Clearly, the national research agenda should include studies to determine why this less-than-adequate care is rendered to the poor and how to render them optimal care."

Brawley concluded, "We must provide equal quality medical care to all. The solutions are not simple, but we must try."