Non-whites at higher risk for pain with metastatic breast cancer

November 27, 2007
A new study finds significant racial differences in the risk of pain related to metastatic breast cancer. An analysis by Dr. Liana Castel of the University of North Carolina at Chapel Hill and colleagues found that non-whites experience poorer pain control among women with this disease.

The study will be published in the Jan. 1, 2008 issue of CANCER, the journal of the American Cancer Society.

Studies indicate that chronic or recurrent pain affects 30 percent of all cancer patients and 60 to 90 percent of patients with advanced cancer. Age, race, tumor type, genetics, psychosocial context and culture can all affect pain. However, it is unclear how pain is influenced by changes over the course of disease due to factors including radiation, surgery and chemotherapy. The current study was among the first to examine whether race plays a role in patients’ experiences in pain over the course of metastatic cancer.

Castel and co-investigators studied 1,124 women with metastatic breast cancer and bone metastases who received standard treatment in an international chemotherapy clinical trial conducted from October 1998 to January 2001. The study comprised women in 19 countries; the majority (82 percent) of non-whites were from the United States.

The authors found that non-white women reached a pain level of seven or higher, on a scale of one to 10, significantly earlier during a year of follow-up. A score of seven or higher on the scale commonly designates severe pain. Besides race, other predictors for greater pain were inactive performance status and preceding radiation treatment.

Castel and her co-authors note that their findings confirm published evidence that non-whites are at highest risk for under treatment of pain, including inadequate dosing and poor access to medication. Racial and ethnic minority patients have also been shown to be at greater risk for breast cancer mortality. The authors conclude that future research is needed to uncover and resolve the reasons for these racial disparities. In addition, “clinicians should use information about known risk factors to inform more aggressive and earlier intervention among non-Caucasian women with metastatic breast cancer,” Castel said.

This work was supported by the federal Agency for Healthcare Research and Quality.


School of Public Health contact: Ramona DuBose, director of communications, (919) 966-7467,