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Minorities and the poor receive delayed thyroid cancer treatment

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A new UCLA study has found that, compared to Caucasian patients and those in higher economic brackets, minority patients and those of lower socioeconomic status are far more likely to have advanced thyroid cancer when they are diagnosed with the disease. The study, which comprised almost 26,000 thyroid cancer patients was published in the January edition of the Journal of Endocrinology and Metabolism.

“Race, social status, wealth and health insurance coverage make a difference in how far a thyroid cancer has advanced by the time a patient first sees a doctor,” noted lead study author Dr. Avital Harari, an assistant professor of general surgery in the endocrine surgery unit at the David Geffen School of Medicine at UCLA. He explained that his team members are hopeful that the study will result in the development of strategies focused on increasing access to healthcare and help make doctors who treat thyroid cancer patients more aware of how aggressive this cancer can be among certain socioeconomic and racial groups. He said, “We hope our work highlights the importance of developing interventions that will lead to equalization of care, better preventative practices and earlier treatments.”

Compared to other types of cancer, the overall incidence of thyroid cancer is low; however, it has been increasing in recent decades. Dr. Harari said that the uptick cannot fully be explained by improved diagnostics or earlier identification of the disease in patients. In general, advanced thyroid cancers are very treatable; however, some may have an increased morbidity and mortality risk, especially if the cancer has spread beyond the thyroid.

Previous studies have shown that exposure to family history, an underactive thyroid, and radiation exposure are known risk factors for thyroid cancer; however, the UCLA researchers were interested in determining other factors that may be contributing to both the increase in this cancer and the diagnosis of the disease in its advanced stages. The investigators reviewed California Cancer Registry data from 25,945 patients with advanced thyroid cancer from 1999 through 2008. The majority of patients, 14,802 (57%), were Caucasian; 6,303 (24%) were Hispanic; 3,901 (15%) were of Asian/Pacific Islander descent; and 939 (4%) were African American. Among all ethnic groups, patients with low socioeconomic status had more advanced disease than those with higher incomes. African American patients consistently presented with later stages of disease and had worse survival rates than any other racial group. In addition, even after adjusting for age, sex, socioeconomics, and type of health insurance, minority groups continued to have higher odds of presenting with more advanced disease than Caucasians.

An interesting finding was that Hispanic and Asian/Pacific Islander patients appeared to survive longer than others, even when presenting with later stages of disease. Dr. Harari noted that additional research in this area is needed to further understand this protective benefit in certain races. He suggested that it could be due to a difference in tumor biology or perhaps genetic variances. Another finding was that patients who were poor and uninsured or who had Medicaid (MediCal in California) had higher odds of presenting with metastatic disease than patients with private health insurance. The researchers noted that their study adds to their previous research, which found that obesity increased the odds of developing advanced thyroid cancer.