Disparities in Breast Cancer Incidence, Mortality, and Quality of Care among African American and European American Women in South Carolina

Abstract

Breast cancer is the most frequently diagnosed cancer among women and the second-leading cause of cancer death in United States women. African Americans and other minorities in the United States suffer lower survival and worse prognosis than European Americans despite European Americans having a much higher incidence of the disease. Adherence to breast cancer treatment–quality measures is limited, particularly when the data are stratified by race/ethnicity. We aimed to examine breast cancer incidence and mortality trends in South Carolina by race and explore possible racial disparities in the quality of breast cancer treatment received in South Carolina. African Americans have high rates of mammography and clinical breast exam screenings yet suffer lower survival compared to European Americans. For most treatment-quality metrics, South Carolina fairs well in comparison to the United States as a whole; however, South Carolina hospitals overall lag behind SC COC-accredited hospitals for all measured quality indicators including needle biopsy utilization, breast-conserving surgeries, and timely use of radiation therapy. Accreditation may a have a major role in increasing the standard of care related to breast cancer diagnosis and treatment. These descriptive findings may provide significant insight for future interventions and policies aimed at eliminating racial/ethnic disparities in health outcomes. Further risk-reduction approaches are necessary to reduce minority group mortality rates, especially among African-American women.

Cardiovascular disease incidence among females in South Carolina by type of oral contraceptives, 2000–2013: a retrospective cohort study

“…According to the guidelines set forth by the World Health Organization (WHO) Medical Eligibility Criteria (MEC) for Contraceptive Use, women of age 40 and older are in a lower medical eligibility criteria category regarding use of COCs compared to use of POCs. Use of COCs in women age 40 and older is considered a category 2 recommendation, meaning that it is, “A condition where the advantages of using the method generally outweigh the theoretical or proven risks,” whereas, the use of POCs in women aged 40 and older is a category 1 recommendation, meaning that being of age 40 or older is, “A condition for which there is no restriction for the use of the contraceptive method.” 45 COC use is still generally recommended in women of age 40 and older, but POCs are preferable. However, in our sample, the majority of women older than 40 were using COCs.…”

“…However, in our sample, the majority of women older than 40 were using COCs. 40, 45 Furthermore, the WHO guidelines do not specifically address women who have switched from COCs to POCs, or vice versa. 45 The POC+COC group is a unique group that includes many women who have had to change from COC to POCs, potentially due to a CVD event, breastfeeding; or women who switched from POCs to COCs due to irregular bleeding.…”

“…40, 45 Furthermore, the WHO guidelines do not specifically address women who have switched from COCs to POCs, or vice versa. 45 The POC+COC group is a unique group that includes many women who have had to change from COC to POCs, potentially due to a CVD event, breastfeeding; or women who switched from POCs to COCs due to irregular bleeding. 3,21,43 We found that these women were associated with significantly higher incidence of CVD; however, additional research needs to focus on this understudied group.…”

Racial and Ethnic Differences in Breast Cancer Patients: A Study for Michigan and California

“…Breast cancer affected an estimated 246,660 lives in 2016 alone, with an estimated 30% of newly-diagnosed cancer cases in the U.S. to have been breast cancer diagnoses [1,2,3]. An additional 40,610 female deaths are expected in 2017 due to breast cancer [4].…”

“…Compared to African Americans in the United States, Caucasians have a much higher incidence of breast cancer among women aged 40 or older [1,2]. Caucasians are shown to also have much higher survival rates and better overall prognosis compared to African Americans.…”