Breast cancer prevention and control among the medically underserved

Abstract

In 1986, the National Cancer Institute published its cancer control objectives for the nation, which included projected reductions in breast cancer mortality. The reductions were estimated to be 25.0% from reducing fat, 16.0% from expanding use of breast cancer screening services, and 14.3% from expanding access to state-of-the-art breast cancer treatment. During the same decade, the U.S. population aged and became significantly more ethnically diverse, and accompanying this increase in ethnic diversity was endemic poverty, disproportionately experienced by black and Hispanic minorities. These populations may be seen as medically underserved. With respect to breast cancer, as well as many other cancers, the medically underserved are understudied, not well understood by many in the medical and academic research community, and attended by health care institutions that are under-funded and often do not have the resources necessary to ensure access to state-of-the-art cancer screening, clinical follow-up, diagnosis, and treatment. At the same time, medically underserved women are more likely to be diagnosed with late-stage breast cancer, and some groups (e.g. black women) bear the greatest breast cancer mortality burden in the nation. In this special issue of Breast Cancer Research and Treatment, eight papers describe what we know and what we don't about breast cancer prevention and control in medically underserved populations.

The identified needs of ethnic minority groups with cancer within the community: a review of the literature

“…However, they highlight the persistent socioeconomic differences in terms of education and income levels, the recent timing of immigration and English language proficiency. Kerner (1996) concludes that there is a need to address educational messages and strategies specifically to the needs of the underserved, with guidance from the ethnic minority groups themselves.…”

“…The beliefs of any community will be affected by each individual's level of education and socioeconomic group, added to their own personal outlook on life (Bahl 1996). There is a need to aim the interventions of educational messages and strategies specifically to the needs of the underserved, with guidance from the ethnic minority groups themselves (Kerner 1996). This would involve finding out which minority groups are actually located within a given area; involving ethnic minority groups in the identification of their perceived needs; and involving them in meeting these needs and evaluating any healthcare outcomes.…”

Decision making for breast cancer prevention among women at elevated risk

“…Relevant examples can be found in studies of race and ethnicity in decision making; for instance, subgroups of Asian-American women differ in their use of mammogram screening by ethnicity, health insurance, and SES [105, 181]. Minority populations also include a high proportion of the medically underserved [182], which suggests that understanding decision making may require attention not just to individual-level factors, but also to the communities in which women live and the resources they can access.…”

Holes in the safety net? Assessing the effects of targeted benefits upon the health care utilization of poor New Zealanders

“…The potential to decrease rates of admission and to ease financial deficits has seen hospitals elsewhere begin to initiate joint programmes with primary care providers to reduce rates of hospitalization ( Barnett & Barnett 1999). While the literature suggests that doctor supply and distribution per se appears to have little overall impact on admission rates, a greater supply of GPs does seem to make a difference, particularly if they are available and financially accessible to populations that are particularly poorly served ( Kerner 1996, Krakauer et al . 1996 ).…”