A new study adds to mounting evidence that women with low Researchers Find Education Level/Income Increase Risk of Advanced Breast Cancer Diagnosis (dateline March 30, 2002) | Breast Health News | Imaginis - The Women's Health & Wellness Resource Network

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Researchers Find Education Level/Income Increase Risk of Advanced Breast Cancer Diagnosis (dateline March 30, 2002)

A new study adds to mounting evidence that women with lower incomes and less education are more likely to be diagnosed with advanced breast cancer than women with higher socioeconomic standings. The report is alarming since the chances of survival decrease significantly when cancer is diagnosed in late stages. Prior public health statistics have shown that African-American have the highest death rate from breast cancer, and overall, are more likely to be diagnosed with a later stage of breast cancer than White women. According to the researchers, the new study reinforces the need to provide better healthcare education and access for low-income, less educated women.

To conduct the study, Sharon Stein Merkin, MHS, of Johns Hopkins University School of Hygiene and Public Health, and her colleagues analyzed the relationship between socioeconomic status, race, and advanced breast cancer in New York City. The researchers compiled information from 37,921 breast cancer cases diagnosed in New York City from 1986 to 1995. Census information from 1990 was used to gain knowledge about the women's ethnicity, income level, and education.

Upon completing their analysis, Merkin and her colleagues discovered that the African-American women in the study with lower incomes and education had a 50% higher risk of being diagnosed with advanced breast cancer compared to women with higher income and education levels. Similarly, White women in the lower income/education group had a 75% higher risk of being diagnosed with late stages of breast cancer compared to those in higher income/education groups. The risk of being diagnosed with advanced breast cancer was reduced among the women with higher education levels.

Advanced, or metastatic, breast cancer is the latest stage of the disease in which the cancer has spread past the breast and axillary (armpit) lymph nodes to invade other organs of the body, such as the lungs, liver, bone, or brain. Survival rates among women diagnosed with advanced breast cancer are low: approximately 16% live for five years after their diagnosis. Treatment usually focuses on relieving pain and extending survival time rather than "curing" the patient.

Experts are alarmed by the study's findings, which suggest that low-income, less educated women do not receive sufficient health education or access to healthcare (including both preventive care and treatment). According to the Donella Wilson, PhD, the American Cancer Society's Scientific Program Director for Research and Training Grants, physicians must be aware of the racial and socioeconomic differences among women and how those factors relate to the stage in which their cancers are likely to be diagnosed. Contrary to popular belief, physicians do not treat all patients the same, says Dr. Wilson. There are instances when doctors do not always recommend a certain treatment to their patients because they believe the patient cannot afford it. Dr. Wilson believes the study shows that physicians must attempt to remove their personal bias when treating patients.

The U.S. government is also trying to reduce socioeconomic barriers to healthcare. In October 2000, former President Clinton signed the Breast and Cervical Cancer Prevention and Treatment Act (public law 106-354) that allows states to provide eligible women with Medicaid coverage to pay for the cost of breast or cervical cancer treatment. (Before the bill was signed, low-income women could receive free mammograms and Pap smears through the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program, but they were not eligible for funding for treatment if they were diagnosed with cancer as a result of those screenings).

The National Cancer Institute recommends that all women 40 years of age and older receive screening mammograms every one to two years to help detect breast cancer in its early stages, when the chances for successful treatment and survival are the greatest. Women 50 years of age and older should receive yearly mammograms. In addition, all women 20 years of age and older should practice monthly breast self-exams and receive regular physician-performed clinical breast exams.

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