by Bryant Furlow and Tara Armijo
Oct 15, 2006—Transitional cell carcinoma
(TCC) of the bladder is only half as common
among black Americans as whites but it is far
more likely to kill blacks, say researchers from
the University of Michigan Comprehensive
Cancer Center (Journal of Urology 2006;176
(3):927-934).
Their review of medical records for over
93,000 US bladder cancer patients paints a
disturbing picture of disparate survival rates.
TCC will kill nearly a quarter of blacks diagnos-
ed, reports lead author Cheryl Lee, but only 15
percent of white patients.
Part of the disparity, Lee says, is attributable to
the fact that black patients are more often
diagnosed after bladder cancer has already
spread to other organs.
"African Americans often present with later
stage bladder cancer and have worse cancer-
related survival," agrees John Gore of the
David Geffen School of Medicine at UCLA.
Improvements in early detection among black
men have been achieved over the past
decade, with more patients being diagnosed
when the disease is still localized in the
bladder. But disparities remain—and in
contrast to men, black women have seen little
improvement in early detection rates.
"The 68 percent rate of localized disease in
black patients...is still well below the 80 percent
rate of localized tumors observed in white
patients," notes Lee.
Furthermore, even when patients diagnosed
with early-stage tumors are compared, survival
rates are significantly worse for blacks. That
may be due to more aggressive tumors among
black patients, Lee's team reports.
It could also reflect poorer access to special-
ized medical care.
Racial disparities in survival do not seem easily
attributed to less aggressive treatment for
black patients. Between 1993 and 1999, blacks
were 33 percent more likely than whites to
undergo complete bladder removal and more
than twice as likely to undergo partial bladder
removal plus radiation therapy. The study did
not analyze differences in access to specializ-
ed care among black and white TCC patients
(see companion story).
TCC is the 5th most common cancer in the US.
Each year, more than 61,000 Americans are
diagnosed with bladder cancer and nearly
13,000 die. Tobacco smoking is a significant
risk factor.
The study's lead author, Cheryl T. Lee,
discloses a financial or other relationship with
the Bladder Cancer Advocacy Network.
Oct 15, 2006—Transitional cell carcinoma
(TCC) of the bladder is only half as common
among black Americans as whites but it is far
more likely to kill blacks, say researchers from
the University of Michigan Comprehensive
Cancer Center (Journal of Urology 2006;176
(3):927-934).
Their review of medical records for over
93,000 US bladder cancer patients paints a
disturbing picture of disparate survival rates.
TCC will kill nearly a quarter of blacks diagnos-
ed, reports lead author Cheryl Lee, but only 15
percent of white patients.
Part of the disparity, Lee says, is attributable to
the fact that black patients are more often
diagnosed after bladder cancer has already
spread to other organs.
"African Americans often present with later
stage bladder cancer and have worse cancer-
related survival," agrees John Gore of the
David Geffen School of Medicine at UCLA.
Improvements in early detection among black
men have been achieved over the past
decade, with more patients being diagnosed
when the disease is still localized in the
bladder. But disparities remain—and in
contrast to men, black women have seen little
improvement in early detection rates.
"The 68 percent rate of localized disease in
black patients...is still well below the 80 percent
rate of localized tumors observed in white
patients," notes Lee.
Furthermore, even when patients diagnosed
with early-stage tumors are compared, survival
rates are significantly worse for blacks. That
may be due to more aggressive tumors among
black patients, Lee's team reports.
It could also reflect poorer access to special-
ized medical care.
Racial disparities in survival do not seem easily
attributed to less aggressive treatment for
black patients. Between 1993 and 1999, blacks
were 33 percent more likely than whites to
undergo complete bladder removal and more
than twice as likely to undergo partial bladder
removal plus radiation therapy. The study did
not analyze differences in access to specializ-
ed care among black and white TCC patients
(see companion story).
TCC is the 5th most common cancer in the US.
Each year, more than 61,000 Americans are
diagnosed with bladder cancer and nearly
13,000 die. Tobacco smoking is a significant
risk factor.
The study's lead author, Cheryl T. Lee,
discloses a financial or other relationship with
the Bladder Cancer Advocacy Network.
Bladder cancer is deadlier for blacks than whites
Later diagnosis, more aggressive tumors are factors, researchers say
But other research suggests that poor access to specialized care plays a role
Later diagnosis, more aggressive tumors are factors, researchers say
But other research suggests that poor access to specialized care plays a role
Is Quality of Care a Factor? Differences in the quality of care available to black and white patients are not assessed in the University of Michigan study. But a study published earlier this year reports that mortality rates are markedly higher in blacks undergoing bladder cancer surgery, and that blacks more often have extended post- surgical stays in the hospital (Urology 2006;67:288-293). Researchers often use surgical mortality and longer lengths of hospital stay as proxy measures of poor quality of care. "Most believe insurance and access to specialized care explain these disparities," notes John Gore at UCLA's David Geffen School of Medicine. Gore's own research indicates that black patients often receive less complex reconstructive surgery after bladder removal (Cancer 2006;107:729-737). "In our study, we looked at the different types of reconstruction offered after bladder removal," Gore explains. "Much like survival, African American men are less likely to receive a more optimal surgical reconstruct- ion, and more often receive an incontinent stoma that connects to a bag." Private medical insurance and HMO membership are associated with markedly better access to specialized surgical care. Taken together, studies published this year suggest that blacks diagnosed with bladder cancer are doubly burdened; they are more likely to be diagnosed with aggressive tumors requiring specialized care, but they are often unable to access that life-saving expertise. |
Further reading Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2002. |
