Researchers have long known that African-American women are more likely than white women to have late-stage breast cancer at diagnosis and a shorter survival time. But it has been unclear whether these differences are because of race or socioeconomic status.
To find out, Bradley and her coworkers linked Detroit cancer registry data with Medicaid enrollment files and found 5,719 women with breast cancer. Of those, 593 were insured by Medicaid and had income levels below the federal poverty line. The rest of the women had other forms of insurance or were uninsured.
The authors found that, compared with white women, African-American women were 53% more likely than white women 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.
But when the authors adjusted their data to account for race and socioeconomic factors, differences in these outcomes, except for choice of surgery, nearly vanished. Compared with white women, African-American women were 62% more likely to have no surgery. If the African-American women had surgery, they were 63% more likely to receive breast-conserving surgery.
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.