Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review

Abstract

Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States. (Cancer Epidemiol Biomarkers Prev 2008;17(11):2913 -23) During the last two decades, there has been a growing Black-White disparity in breast cancer mortality (1). Although the overall rate of mortality from breast cancer has been decreasing since the early 1980s, this decrease has occurred at a much faster pace for White women than it has for African American women (Fig. 1). This finding is especially noteworthy because the lifetime incidence of breast cancer is actually lower, not higher, among African American women than among their White counterparts (1).What factors might be responsible for this racial disparity in mortality from breast cancer? Poorer outcomes in African American women, in part, reflect the fact that breast cancer tends to be a more biologically aggressive disease in African Americans than in White Americans (2-6). In addition to biological factors, these disparities also reflect social, economic, and cultural barriers that disproportionately affect African American women. Barriers such as poverty and racism both hinder cancer prevention and control efforts and modify the biological expression of disease (7-10). The current review focuses on delineating the social, economic, and cultural factors potentially responsible for Black-White disparities i...

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.…”

“…Improving health-seeking behavior and trust in the health care system are difficult targets for research interventions, given the complex historical experiences of American minority groups [9,96]. Similarly, advances in understanding of molecular differences in breast cancer by race that will enable individualized therapy are still on the horizon.…”

Influence of Ethnicity on Survival of Breast Cancer Patients in Turkey

“…Impact of the ethnicity on survival rates was reported in previous studies among BC patients (Greend and Pai 2008;Bhoo-Pathy et al, 2012;Spallek et al, 2012;Abdullah et al, 2013). This is the first study from Turkey investigating the influence of ethnicity on survival in women BC population.…”

Development of a Brochure for Increasing Awareness of Inherited Breast Cancer in Black Women

“…Additionally, some women in our sample wanted more specific information about why hereditary breast cancer was relevant to their community. A recent review of social determinants of breast cancer disparities in mortality between black and white women suggest for black women usually consider themselves to be at lower risk for developing breast cancer than do white women (Gerend and Pai, 2008 and Pai, 2008). Thus, including elements such as terms and information unique to black women may help to enhance both the cultural acceptability and personal relevance of the information about HBOC.…”