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Blacks' lower rate of lung cancer surgery not just due to access to care issues
Study suggests racial disparities stem from doctor-patient interaction
27-Dec-2005 - Even when they have equal access to specialized care, blacks with potentially curable lung cancer are about half as likely as whites to undergo surgery that could save their lives, according to a study by Dana-Farber Cancer Institute researchers.
Designed to identify the causes of racial discrepancies in lung cancer treatment in the United States, the research ruled out unequal access to medical care as the sole explanation. It did show that blacks were somewhat less likely to be offered lung cancer surgery, and were slightly more likely to refuse it than were whites. Overall, the study found that blacks who had equal access to care were 45 percent less likely than whites to have lung cancer surgery.
These findings point to a subtle and complex "communications problem" underlying the inequality, said Christopher Lathan, MD, of Dana-Farber and lead author of the report that is published online by the Journal of Clinical Oncology and is scheduled to run in the journal's Jan. 20 print issue. "Something's not happening. There was no specific reason that could be found, but there needs to be more attention paid to the doctor-patient interaction."
The generally poorer health of blacks and other racial minorities is often blamed on social and financial obstacles to obtaining medical care. The new study, however, documents that the lower rate of surgery for black lung cancer patients "is not just about access to care or not being physically able to undergo treatment," said Craig Earle, MD, of Dana-Farber and the paper's senior author. "There still seems to be a racial disparity."
According to the American Cancer Society, lung cancer is the leading cause of cancer deaths among blacks Americans, and blacks have the highest lung cancer mortality rate in the United States. It is estimated that 15,500 blacks will die from lung cancer in the United States in 2005 (accounting for nearly a quarter of all cancer deaths), and that more than 19,000 will be diagnosed with the disease, which is approximately 14 percent of all new cancer cases among blacks.
Yet, blacks have been previously found less likely to get surgical treatment. Someone who is diagnosed before the cancer has spread very far - Stage I or II - has up to a 50 percent chance of being alive at five years if surgery is performed. Untreated, the disease is almost always fatal.
The researchers, who also included Bridget Neville, MPH, of Dana-Farber, analyzed cancer registry records and insurance claims of 21,219 Medicare-eligible patients diagnosed with non-metastatic lung cancer between 1991 and 2001. With Medicare, inequalities due to insurance coverage were eliminated. Of these patients, 14,224 had undergone invasive procedures to "stage" the disease by its extent, which is a guide to treatment decisions.
The procedures included bronchoscopy, the insertion of a viewing tube into the lungs, and mediastinoscopy and thoracoscopy, where surgeons make incisions in the chest wall under general anesthesia, through which viewing scopes are placed. Blacks were 25 percent less likely than whites to have staging examinations.
But even after being referred for and undergoing staging, only 36 percent of blacks – but 50 percent of whites – were among the 6,972 who went on to receive surgical treatment. The difference in surgery rates was 45 percent.
"We thought that if all the patients had been staged – which suggests that they had access to the appropriate specialists and implies some level of trust in the medical system – that they would have the same rate of surgery," said Lathan. "We were quite surprised to find this was not the case."
The study did not address cultural factors, but Lathan said blacks might be mistrustful of the medical system and less aware of the potential benefits of the invasive surgery. Lathan, who is black and treats lung cancer patients, added that physicians may be less inclined to try and persuade reluctant black patients to strongly consider the surgery, particularly if a patient lacks good social support during recovery.
While urging further study, Lathan advised all patients to "make sure they're getting all the resources they need, even if it means challenging their physicians a little bit." For physicians, he added, "it's really important that we spend as much time thinking about how we communicate with our patients as we do about how to treat them."
Contact: Bill Schaller
william_schaller@dfci.harvard.edu
617-632-5357
Dana-Farber Cancer Institute
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The study was funded by Dana-Farber and by a National Institutes of Health training grant.
Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute.
Asbestos found at 10 stations
From: AAP
March 30, 2006 - ASBESTOS has been found at another two Sydney train stations during an audit of CityRail properties, taking the number to 10.
Tests at Wollstonecraft and Lidcombe stations had returned positive results for disturbed asbestos, RailCorp said in a statement.
RailCorp acting chief executive Rob Mason said Lidcombe was cleared yesterday while remedial works at Wollstonecraft were continuing.
Asbestos fibres have already been detected at Clyde, Regents Park, Camellia, Cheltenham, Edgecliff, Normanhurst, Thornleigh, Eastwood.
Tests on a suspect wall at Redfern Station earlier this week proved negative.
Cheltenham, Normanhurst, Thornleigh, Lidcombe and Edgecliff will return to normal services today after being cleared of the asbestos threat and clean ups continue at the other stations.
Ex-military base community resist ‘forced’ removal
April 23, 2006, 20:15
Hundreds of families at Pomfret in the Northern Cape are refusing to relocate and are taking the government to court. The families allege they are victims of a 'forced’ removal.
The town served as a military base during the apartheid era. The families are all descendants of Angolans, who belonged to the former Koevoet counter-insurgency unit.
The government decided last year to move the community because of the high incidence of Asbestosis arising from decades of asbestos mining in the area. The community has rejected the grounds for their removal.
Move politically motivated
Meanwhile Angela McIntyre, a University of the Witwatersrand researcher who has been in the area to study the impact of the asbestos mines, says she believes the decision does not arise from a health consideration.
A small minority of the people, she says, were part of the former South African Defence Force and there is thus a political motivation.
Victims sue government over asbestos
THE ASAHI SHIMBUN
05/27/2006 - OSAKA--In the first group lawsuit against the government over asbestos, eight people Friday demanded compensation for what they said was the state's decades of neglect in dealing with a known health hazard.
The plaintiffs in the lawsuit filed at the Osaka District Court claim the government is responsible for their suffering because it took no action against factories that produced or used asbestos, despite being fully aware nearly 70 years ago of patients suffering from asbestosis, a lung disease caused by inhaling asbestos particles.
They are seeking a total of 244 million yen. The plaintiffs include four former factory workers between 64 and 79 years old with asbestos-related diseases. The other plaintiffs are family members of two workers and two residents who died of illnesses at or near factories that handled asbestos in the Sennan district in southern Osaka Prefecture.
"I can't make any comment on this because I haven't seen the complaint yet," Environment Minister Yuriko Koike told reporters in Tokyo.
But she pointed to a Cabinet report on asbestos countermeasures last year, which did not admit the state's responsibility.
According to the plaintiffs' complaint, the Sennan district became a major asbestos manufacturing site after 1907. Many small, poorly maintained asbestos-related factories popped up with work forces of around 10.
The former factory workers were exposed to huge amounts of asbestos particles when they worked in the area for between eight and 31 years, according to the complaint.
The lawsuit also says people got sick after inhaling asbestos particles in their homes and agricultural fields near those factories.
The plaintiffs said the central government conducted surveys on at least 1,000 workers at 19 factories in the Sennan district and other areas with asbestos factories between 1937 and 1940.
The results showed that about 60 percent of people who had worked for 10 to 15 years in those areas suffered from asbestosis. The rate shot up to 100 percent among those working for 20 years or more.
The plaintiffs argue that the state was fully aware of the health risks of asbestos.
They also noted that factory doctors in those days had called for government regulations to prevent further damages, but the state neglected its duties to supervise those plants and protect lives.
Such inaction violates the principle of respecting human lives under Article 13 of the Constitution, they said.
Under the new asbestos relief law, the government in March started accepting applications from asbestos victims seeking compensation.
The law covers residents living near factories who have mesothelioma and other types of lung cancer caused by asbestos, as well as bereaved family members of former factory workers not covered by insurance.
But the plaintiffs said asbestosis and other illnesses are excluded from the scope of redress under that law.(IHT/Asahi: May 27,2006)
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