Women's Health

Japanese and Filipino women are much less likely than white women to undergo breast-conserving therapy for breast cancer

A new study reveals disparities in the management of early-stage breast cancer among Asian American and Pacific Islander (AAPI) women, particularly among Japanese and Filipino women. Researchers found that in Hawaii, Japanese and Filipino women were less likely than white women to undergo recommended breast-conserving surgery (BCS) for early-stage breast cancer. Japanese women were diagnosed with earlier stage cancer, whereas Filipino and Hawaiian women were more likely to be diagnosed at more advanced stages.

Researchers linked data from the Hawaii Tumor Registry to healthcare claims and census information to create a database of information on patient and tumor characteristics and primary treatment. They retrospectively analyzed breast cancer management of 2,030 women (935 Japanese, 144 Chinese, 235 Filipino, 293 Hawaiian, and 423 white women), who were diagnosed with early breast cancer (stages I, II, and IIIA) in Hawaii from 1995 to 2001. They evaluated BCS, radiotherapy after BCS, and chemotherapy for lymph node-positive cancer.

Only 55.6 percent of women received BCS; 85.1 percent of these women also received radiation. Of those with lymph node involvement, 82.7 percent received chemotherapy. Japanese and Filipino women were 38 percent and 53 percent, respectively, less likely than white women to undergo BCS. Filipino women were 20 percent less likely than white women to receive recommended radiation after BCS. However, AAPI women overall were as likely as white women to receive adjuvant chemotherapy for cancer spread to the lymph nodes. The disparities in management of early-stage breast cancer were not entirely explained by differences in patient and tumor characteristics, suggesting that women of certain ethnic groups may not be completely exercising their choice of surgery (mastectomy vs. BCS). On the other hand, ethnic variation in breast size (small breasts make the cosmetic outcome of BCS unacceptable to some) and cultural differences may explain some of the observed differences. The study was supported by the Agency for Healthcare Research and Quality (HS11627).

See "Ethnic disparities in breast cancer management among Asian Americans and Pacific Islanders," by Rebecca P. Gelber, M.D., M.P.H., Ellen P. McCarthy, Ph.D., M.P.H., James W. Davis, Ph.D., and Todd B. Seto, M.D., M.P.H., in the July 2006 Annals of Surgical Oncology 13(7), pp. 977-984.

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