Disparities in Breast Cancer Deaths

A recent article in the New York Times highlighted the disparities in breast cancer survival for black women.   This is certainly not a new problem, nor is it the first time the issue has been written about, and yet the disparity persists.  Even though breast cancer is more common (has a higher incidence) in white women, it is more deadly for black women.  Almost 70% of white women diagnosed with breast cancer will reach the 5 year survival mark, whereas only 56% of black women will.  This difference can’t be explained away using biology either.  Even though the deadliest kind of breast cancer is more common in black women, it only represents 10% of diagnosed cases.

Female Breast Cancer Incidence and Death Rates (from Cancer.gov)

	Breast
Racial/Ethnic Group	Incidence	Death
All	127.8	25.5
African American/Black	118.3	33.8
Asian/Pacific Islander	89.0	12.6
Hispanic/Latino	89.3	16.1
American Indian/Alaska Native	69.8	16.1
White	132.5	25.0

Statistics are for 2000-2004, age-adjusted to the 2000 U.S. standard million population, and represent the number of new cases of invasive cancer and deaths per year per 100,000 women.*

 

In 2011, Whitman, Orsi and Hurlbert published “The racial disparity in breast cancer mortality in the 25 largest cities in the United States” in Cancer Epidemiology, which studied the breast cancer disparities in the 25 most populous US cities.  They found that eight cities had statistically significant disparities that were worse than the US as a whole which had a rate ratio of 1.4 (1.4 breast cancer deaths of black women for every 1 death for white women).  The eight cities were Memphis (2.09), Denver (1.74), Los Angeles (1.7), Houston (1.65), Chicago (1.61), Milwaukee (1.61), Boston (1.59), San Diego (1.49) and Dallas (1.48).  

Even though the issue of breast cancer disparities has been around for many years, this seems to be the first and only study looking into disparities are a local level.  These types of studies are important in reducing disparities as they generally get a response from local governments, media and communities.  After the study was published Chicago passed an ordinance to increase the distribution of cancer screening resources.  Moreover, the Senior Vice President for Strategic Planning at one of the largest hospital chains in Memphis convened a meeting with the study’s authors and other experts to brainstorm ways to reduce the disparity in the city at the top of the list.  Some other city and local newspapers covered the study while pointing out their own score (Denver, Houston).  

What Is Causing This Disparity?

The Whitman, Orsi and Hurlbert study found that median income and segregation were significantly related to a city’s rate ratio.  Which is no surprise as those tend to come up when studying all kinds of disparities.  Income is a huge social determinant of health - the World Health Organization (WHO) states that “higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.”  Segregation generally results in a lack in access to health centers, doctors and hospitals. The farther doctors are, the longer an individual has to take off of work or the harder it is to find transportation - people of color tend to be the least able to get past these barriers.

What this all means is that black women generally get diagnosed with breast cancer at later stages than white women.  Once a cancer is at stage III or IV, the survival rate plummets (the relative 5 year survival rate for a woman diagnosed with stage 2 breast cancer is 93% whereas stage 3 and 4 are 72% and 22% respectively).  Black women also generally start their treatment later than white women.  Lack of access to care is not the only reason why black women tend to be diagnosed and received care later.  There is still a great deal of distrust of doctors and hospitals in black communities because of abuses like the Tuskegee syphilis experiment (where doctors studied the progression of syphilis in black men without telling them they had the disease or treating them for it).  A great book that looks at another example of how the medical establishment mistreated black patients is The Immortal Life of Henrietta Lacks.  

What Can We Do?

Tackling health disparities as an individual can often feel overwhelming, but there are things you can do, especially when it comes to supporting breast cancer screening and early treatment.  One of the biggest is to support health centers like Planned Parenthood which are often the best option for not only breast cancer screening, but also cervical cancer screening (another area where there is a disparity between black and white women).  Also, get involved with local politics and advocate for the equitable distribution of funds for health care and health centers.