Source: in.reuters.com
Author: Frederik Joelving

Blacks in the United States with throat cancer are more likely than whites to have surgery that leaves them unable to speak than to get gentler voice-preserving therapy, according to a study. Previous research has found a similar racial disparity in breast cancer treatment, with blacks more often having the entire breast removed instead of just the cancerous lumps. It’s unclear why the disparity exists. But study leader Allen Chen, a radiation oncologist at University of California, Davis, said that poverty, less education and deep-rooted historical biases could all be at work.

“There could be an underlying distrust among African Americans where they feel anything less than surgery might be considered quote-unquote experimental,” Chen told Reuters Health.

He referenced the Tuskegee experiment, conducted by the U.S. government from the 1930s into the 1970s, in which black patients with syphilis went untreated despite assurances to the contrary.

“That sort of distrust needs to be addressed or alleviated,” Chen said, because voice-preserving treatment for throat cancer, based on radiation and drug therapy, is now the standard.

His study, published in the Archives of Otolaryngology – Head & Neck Surgery, is based on data from a US cancer registry including nearly 5,400 cases of laryngeal cancer between 1991 and 2008.

About 80 percent of whites had voice-preserving treatment, while the rest had their voice box surgically removed – the traditional approach. Among blacks, 75 percent had the gentler therapy. While that’s only a five-percent difference, “I think that’s a gap that needs to be narrowed,” Chen added.

The racial disparity remained after researchers accounted for age, sex and how advanced patients’ tumors were, and it didn’t disappear in the more recent half of the study, either. However, there was no significant gap between whites and Hispanics or Asians. The study didn’t look at income or education, which might explain some of the difference. It’s also possible that more blacks lived in areas without access to the resources involved in voice-preserving therapy, which requires cooperation between doctors with different specialties.

While the gentler therapy might be just as effective as surgery, an operation does have the advantage of being over at once, whereas it takes several weeks of treatment for drugs and radiation to work.

But if it’s a question of people believing treatment other than surgery is experimental, he added, “That perception needs to be changed.”

Source: Reporting from New York by Frederik Joelving at Reuters Health; editing by Elaine Lies and Bob Tourtellotte