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

Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 12/2008; 17(11):2913-23. DOI: 10.1158/1055-9965.EPI-07-0633
Source: PubMed


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.

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    • "Despite the health implications of racial and gender disparities in utilisation, most research in this area focuses on acute physical or mental health services and service utilisation among the elderly (Ojeda and Bergstresser 2008, Shenson et al. 2012, Williams and Mohammed 2009). In addition, with the exception of studies examining end-of-life care and cancer treatment decisions, few existing utilisation studies examine the role of factors like religiosity, cultural attitudes and experiences, and social support that may be particularly relevant to African American women (Gerend and Pai 2008, Johnson et al. 2005). Importantly, the findings of this extant research cannot be expected to translate to preventative care utilisation. "
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    ABSTRACT: Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low-income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help-seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.
    Sociology of Health & Illness 04/2014; 36(7). DOI:10.1111/1467-9566.12141 · 1.88 Impact Factor
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    • "Regardless of race/ethnicity, women in the quartile with the most poverty experience a lower percentage of breast cancer cases being detected at early stages and a higher percentage of cases detected at advanced stages, compared to women in the quartile with the least poverty. This finding supports the well-documented association between poverty and poorer breast cancer outcomes [18]. The same relationship is observed for education. "
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    ABSTRACT: This study investigated the role of key individual- and community-level determinants to explore persisting racial/ethnic disparities in breast cancer stage at diagnosis in California during 1990 and 2000. We examined socio-demographic determinants and changes in breast cancer stage at diagnosis in California during 1990 and 2000. In situ, local, regional, and distant diagnoses were examined by individual (age, race/ethnicity, and marital status) and community (income and education by zip code) characteristics. Community variables were constructed using the California Cancer Registry 1990-2000 and the 1990 and 2000 U.S. Census. From 1990 to 2000, there was an overall increase in the percent of in situ diagnoses and a significant decrease in regional and distant diagnoses. Among white and Asian/Pacific Islander women, a significant percent increase was observed for in situ diagnoses, and significant decreases in regional and distant diagnoses. Black women had a significant decrease in distant -stage diagnoses, and Hispanic women showed no significant changes in any diagnosis during this time period. The percent increase of in situ cases diagnosed between 1990 and 2000 was observed even among zip codes with low income and education levels. We also found a significant percent decrease in distant cases for the quartiles with the most poverty and least education. Hispanic women showed the least improvement in breast cancer stage at diagnosis from 1990 to 2000. Breast cancer screening and education programs that target under-served communities, such as the rapidly growing Hispanic population, are needed in California.
    BMC Public Health 11/2013; 13(1):1061. DOI:10.1186/1471-2458-13-1061 · 2.26 Impact Factor
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    • "Many studies indicate that breast cancer health disparities exist among women of different races, ethnicities, socioeconomic statuses, geographic locations and age [1, 2]. According to the Centers for Disease Control and Prevention (CDC), National Program of Cancer Registries (NPCR) while the age-adjusted incidence rate of breast cancer among black females is slightly lower than that of white females, the mortality rates from breast cancer are significantly higher among black females [3, 4]. "
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    ABSTRACT: Mobile health units are increasingly utilized to address barriers to mammography screening. Despite the existence of mobile mammography outreach throughout the US, there is a paucity of data describing the populations served by mobile units and the ability of these programs to reach underserved populations, address disparities, and report on outcomes of screening performance. To evaluate the association of variables associated with outcomes for women undergoing breast cancer screening and clinical evaluation on a mobile unit. Retrospective analysis of women undergoing mammography screening during the period 2008-2010. Logistic regression was fitted using generalized estimating equations to account for potential repeat annual visits to the mobile unit. In total, 4,543 mammograms and/or clinical breast exams were conducted on 3,923 women with a mean age of 54.6, 29 % of whom had either never been screened or had not had a screening in 5 years. Age < 50 years, lack of insurance, Hispanic ethnicity, current smoking, or having a family relative (<50 years of age) with a diagnosis of cancer were associated with increased odds of a suspicious mammogram finding (BIRADS 4,5,6). Thirty-one breast cancers were detected. The mobile outreach initiative successfully engaged many women who had not had a recent mammogram. Lack of insurance and current smoking were modifiable variables associated with abnormal screens requiring follow up.
    Journal of Community Health 05/2013; 38(5). DOI:10.1007/s10900-013-9696-7 · 1.28 Impact Factor
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