Racial and Ethnic Disparities in Breast Cancer Mortality: Are We Doing Enough to Address the Root Causes?

Abstract

Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health system-level factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities.

Disparities in Breast Cancer Treatment and Outcomes: Biological, Social, and Health System Determinants and Opportunities for Research

“…In epidemiological terms, racial and ethnic differences in breast cancer-related morbidity and mortality can be thought of as being produced by multiple complementary causes [9,14], none of which is sufficiently explanatory alone. Possible explanations for enduring racial and ethnic disparities include biological differences in tumor behavior and morphology [6, 26, 28 -30], differences in therapeutic response [31], patient-level psychosocial or behavioral factors [32], socioeconomic status and access to care [9,33,34], and treatment differences [8,11,35]. Determining which of these multifaceted factors can be adjusted to improve outcomes is vital and requires deeper understanding of the complex relationships between biological, behavioral, and social determi- nants of health.…”

Breast Cancer Molecular Subtypes and Associations with Clinicopathological Characteristics in Iranian Women, 2002-2011

“…Based on geographical diversity in incidence and the mortality rates of breast cancer subtypes and because of correlations between clinical outcomes and race and ethnicity (Carey et al, 2006;Blackman & Masi, 2006), we carried out this study to find out the demographic distribution of breast cancer molecular subtypes among Iranian women. Further, we evaluated the association of each subtype with some of the clinicopathological features and prognostic parameters, including patient's age, histological type, tumor size, tumor grade, vascular and perineural invasions and lymph node involvement at the time of surgery.…”

Cancer Health Disparities: What We Have Done

“…There are documented disparities in knowledge and awareness of the disease. 14,15 In addition, there are documented disparities in access to health care, resulting in differential treatment of the disease. 4,14,15 Moreover, where cancer treatment is available, there is evidence of disparities in the quality of treatment.…”

“…14,15 In addition, there are documented disparities in access to health care, resulting in differential treatment of the disease. 4,14,15 Moreover, where cancer treatment is available, there is evidence of disparities in the quality of treatment. 4,14 Recent findings suggest that African Americans and whites have similar disease outcomes when they receive similar cancer treatment and medical care.…”

“…4,14,15 Moreover, where cancer treatment is available, there is evidence of disparities in the quality of treatment. 4,14 Recent findings suggest that African Americans and whites have similar disease outcomes when they receive similar cancer treatment and medical care. 4 …”