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An interdisciplinary team led by Columbia University Medical Center received a $10 million grant from the Department of Defense to assess why breast cancer remains under-treated among black women and to better understand the disparities in survival rates.

Despite the substantially improved survival rates of women who receive adjuvant therapy following surgery, studies have shown that 30 percent or more of breast cancer patients fail to receive complete treatment, and that black women are as much as 10 percent less likely than white women to receive the optimal recommended doses.

"Identifying the barriers to optimal treatment will enable us to intervene to reduce racial disparities and to improve survival for all women with breast cancer," said Alfred I. Neugut, M.D., Ph.D., professor of Medicine and Epidemiology at Columbia University Medical Center, co-director of the Cancer Prevention Program at NewYork-Presbyterian Hospital/Columbia, and the principal investigator of the DOD-funded Breast Cancer Center of Excellence.

The Center will examine possible reasons for the disparity, including a lack of referrals to medical oncologists, miscommunication between patients and physicians, economic and cultural differences between patients and physicians, physical tolerance of therapy, and variations in the metabolism of chemotherapy.

"Little is known about the reasons for this failure, but we believe the causes of this racial disparity are potentially modifiable," said Dawn Hershman, M.D., M.S., Assistant Professor of Medicine and Epidemiology at Columbia's Mailman School of Public Health, Director of the Clinical Breast Oncology Program at New York-Presbyterian/Columbia and the co-principal investigator of the Center.

The Center will be a collaboration of experts from Columbia University College of Physicians and Surgeons, the Mailman School of Public Health at Columbia University, and New York-Presbyterian Hospital, among other institutions. Housed at NewYork-Presbyterian Hospital/Columbia University Medical Center, the Center will bring together experts in medical and surgical oncology, epidemiology, biostatistics, behavioral oncology, communications research, consumer advocates, health outcomes research, and molecular genetics to address these issues.

The new DOD-funded Breast Cancer Center of Excellence will study 900 black and 900 white breast cancer patients from two already funded studies. One is a study of etiologic factors for breast cancer in black and white women at eight hospitals in New York City under the direction of Dr. Dana Bovbjerg of Mt. Sinai and Dr. Christine Ambrosone of Roswell Park Cancer Center. The second study, headed by Dr. Larry Kushi of Kaiser Permanente in California, is funded by the National Cancer Institute to assess the impact of lifestyle risk factors on breast cancer survival outcomes.

The Center will conduct interviews with the 1,800 women to collect information on referrals to oncologists, recommended therapy, psychological status, cultural and personal values and preferences and perceptions of physician patient interaction. Researchers will ascertain patients' adherence to the recommended chemotherapy, dose-intensity, and toxicities and collect clinical information and blood specimens. The oncologists treating the patients will be surveyed about their attitudes towards treatment. Patient medical records will be reviewed to gather data on incomplete treatment and the reasons for it.

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, medical education, and health care. The medical center trains future leaders in health care and includes the dedicated work of many physicians, scientists, nurses, dentists, and other health professionals at the College of Physicians & Surgeons, the School of Dental & Oral Surgery, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. With a strong history of some of the most important advances and discoveries in health care, its researchers are leading the development of novel therapies and advances to address a wide range of health conditions.

New York-Presbyterian Hospital is the largest not-for-profit, non-sectarian hospital in the country. It provides state-of-the art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: New York-Presbyterian hospital/Columbia University Medical Center, New York-Presbyterian Hospital/Weill Cornell Medical Center, Children's Hospital of New York-Presbyterian, the Allen Pavilion, and the Westchester Division. It consistently ranks as one of the top hospitals in the country in U.S.News & World Report's guide to "America's Best Hospitals." The New York-Presbyterian Healthcare System – an affiliation of acute-care and community hospitals, long-term care facilities, ambulatory sites, and specialty institutes – serves one in four patients in the New York metropolitan area.

The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 850 graduate students in pursuit of masters and doctoral degrees. Its students and 250 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences.