Blacks do just as well
with equal cancer
treatment

November 17, 1999
Web posted at: 1:56 PM EST (1856 GMT)

WASHINGTON (Reuters) --
When blacks receive the same
care as whites, they are no
more likely to die of colon
cancer, suggesting that poorer
quality care and not biology is
responsible for the higher
death rates seen among U.S.
blacks, researchers said Tuesday.

James Dignam of the University of Pittsburgh and
colleagues said they examined information from five
different clinical trials on colon cancer treatment, with
663 blacks and 5,969 whites enrolled in the trials.

The researchers said all the patients were treated exactly
the same and received the careful care that is required of
clinical studies, which are conducted to compare
different therapies -- in this case, five different cancer
drugs given to patients after surgery.

Writing in the Journal of
the National Cancer
Institute, the researchers
said the blacks enrolled in
the clinical trials were just
as likely as whites to
survive their colon cancer.

Experts said the study
suggested that differences
in diagnosis and treatment,
not some inherent genetic
or other biological
difference, accounted for
the poorer outcomes
among U.S. blacks
suffering from colon cancer.

"This finding raises deep ethical and moral questions,"
Dr. Otis Brawley of the National Cancer Institute and Dr.
Harold Freeman of the North General Hospital in New
York wrote in a commentary for the journal.

Dignam's team found that 70 percent of the whites and 68
percent of the blacks in the trials were still alive and free
of cancer five years after treatment, and 62 percent of
whites and 60 percent of blacks were alive and free of
any disease at all after five years. Those survival rates
are considered comparable.

Brawley and Freeman said that in the real world, the
outcomes are much different.

"In 1996 the colorectal cancer death rate was 16.4 per
100,000 for white Americans and 22.5 per 100,000 for
black Americans. Blacks disproportionately receive less
aggressive or less appropriate therapies than whites for
cancer and for a number of other diseases," they wrote in
their commentary.

For instance, one study showed that 78 percent of whites
were given surgery for their colon cancer, but only 68
percent of blacks underwent surgery.

"One cannot help but hypothesize that the increasing
colon cancer disparity is because medical research has
found efficacious treatments and society has not
disseminated these treatments equally throughout the
population," Brawley and Freeman wrote.

They noted that blacks, perhaps because they mistrust the
health care system, often wait longer to go to doctors, and
this may mean they have more advanced cancer when
they do seek treatment.

But even at the same stage of disease, blacks are more
likely to die of cancer than whites are, experts said.

Doctors used to think there could be some biological
reason to explain the differences in mortality, but
Brawley and Freeman said this study "makes one realize
that race should not be a factor in determining the
treatment of cancer patients."

Colon cancer is the second most common cause of cancer
death in the United States. It is expected to kill 48,000
people this year.

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