Article

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 &amp Prevention (Impact Factor: 4.56). 12/2008; 17(11):2913-23. DOI: 10.1158/1055-9965.EPI-07-0633
Source: PubMed

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.

0 Bookmarks
 · 
108 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to assess treatment and mortality differences between women diagnosed with breast cancer through Nebraska's Every Woman Matters (EWM) program and women diagnosed through other sources.
    Breast Cancer Research and Treatment 06/2014; · 4.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Wage theft, or nonpayment of wages to which workers are legally entitled, is a major contributor to low income, which in turn has adverse health effects. We describe a participatory research study of wage theft among immigrant Chinatown restaurant workers. We conducted surveys of 433 workers, and developed and used a health department observational tool in 106 restaurants. Close to 60% of workers reported 1 or more forms of wage theft (e.g., receiving less than minimum wage [50%], no overtime pay [> 65%], and pay deductions when sick [42%]). Almost two thirds of restaurants lacked required minimum wage law signage. We discuss the dissemination and use of findings to help secure and enforce a wage theft ordinance, along with implications for practice.
    American Journal of Public Health 06/2014; 104(6):1010-20. · 3.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Improvement in breast cancer survival has been observed in recent decades in the U.S., but it is unclear if similar survival gains are consistent across breast cancer subtypes, especially with regards to more advanced stages of the disease. Data were from 13 population-based cancer registries participating in the surveillance, epidemiology, and end results (SEER) program, consisting of women between 20 and 79 years of age diagnosed with invasive breast cancer between 1992 and 2008. 2-year (1992-2008) and 5-year (1992-2006) breast cancer cause-specific survival rates were calculated and stratified by estrogen receptor (ER)/progesterone receptor (PR) status, stage, and race. Annual percent changes in survival rates were assessed. From 1992 through 1998-1999, 5- and 2-year cause-specific survival rates significantly improved across ER+/PR+, ER-/PR-, and ER+/PR- subtypes, with an annual increase ranging from 0.5 to 1.0 % in the 5-year rates. From 1998-1999 to 2006, different patterns were observed by ER/PR subtypes with survival rates slightly improving for ER+/PR+, continuing to improve at a rate of 0.5 % per year for ER-/PR-, and dropping 0.3 % annually for ER+/PR-. No significant survival gains were experienced by patients with ER-/PR+ cancer during the study period. In terms of advanced diseases, greatest annual increases in survival rates were seen for patients with stage III-IV ER+/PR+ and ER-/PR- tumors but less progress was observed for advanced ER+/PR- breast cancers. Steady improvements in survival rates for breast cancer have been achieved over the past several decades. However, 5-year survival rates for stage IV disease remained dismally below 20 % for most ER/PR subtypes.
    Breast Cancer Research and Treatment 08/2014; · 4.47 Impact Factor