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.
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ABSTRACT: This paper examines the effect of neighborhood disadvantage on racial disparities in ovarian cancer-specific survival. Despite treatment advances for ovarian cancer, survival remains shorter for African-American compared to White women. Neighborhood disadvantage is implicated in racial disparities across a variety of health outcomes and may contribute to racial disparities in ovarian cancer-specific survival. Data were obtained from 581 women (100 African-American and 481 White) diagnosed with epithelial ovarian cancer between June 1, 1994, and December 31, 1998 in Cook County, IL, USA, which includes the city of Chicago. Neighborhood disadvantage score at the time of diagnosis was calculated for each woman based on Browning and Cagney's index of concentrated disadvantage. Cox proportional hazard models measured the association of self-identified African-American race with ovarian cancer-specific survival after adjusting for age, tumor characteristics, surgical debulking, and neighborhood disadvantage. There was a statistically significant negative association (-0.645) between ovarian cancer-specific survival and neighborhood disadvantage (p = 0.008). After adjusting for age and tumor characteristics, African-American women were more likely than Whites to die of ovarian cancer (HR = 1.59, p = 0.003). After accounting for neighborhood disadvantage, this risk was attenuated (HR = 1.32, p = 0.10). These findings demonstrate that neighborhood disadvantage is associated with ovarian cancer-specific survival and may contribute to the racial disparity in survival.Frontiers in Public Health 01/2015; 3:8.
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ABSTRACT: The purpose of this qualitative study was to conduct a formative evaluation of messages and materials to inform the development of a promotional, health campaign designed to increase breast cancer screening awareness and utilization among low-income, uninsured African American women through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in Savannah and Macon, Georgia (GA). A priority of CDC is to understand why women eligible for screening through the NBCCEDP do not participate in NBCCEDP screening services as well as to identify effective strategies for increasing enrollment among NBCCEDP-eligible women who have never received breast cancer screening. As such, eight focus groups were conducted with a sample of African American women (n = 68) in two cities in GA. The participants in the focus groups were segmented by age (40–49 and 50–64 years) and mammography screening status. A thematic analysis of field notes was conducted to assess themes and patterns in the participants' perception of the promotional, health campaign's concepts, messages, and materials. The findings revealed common themes and identified several key issues to address in the refinement of campaign messages and materials, including the need to hear about breast cancer and the importance of screening from African American breast cancer survivors as well as to incorporate religious faith and family connectedness messages in materials. The study findings have implications for enhancing breast cancer prevention efforts in the African American community.
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ABSTRACT: The authors investigated whether residential segregation (the degree to which racial/ethnic groups live separately from one another in a geographic area) 1) was associated with mortality among urban women with breast cancer, 2) explained racial/ethnic disparities in mortality, and 3) whether its association with mortality varied by race/ethnicity. Using Texas Cancer Registry data, all-cause mortality and breast-cancer mortality were examined among 109,749 urban black, Hispanic, and white women aged ≥50 years who were diagnosed with breast cancer from 1995 to 2009. Racial (black) segregation and ethnic (Hispanic) segregation of patient's neighborhoods were measured and were compared with the larger metropolitan statistical area using the location quotient measure. Shared frailty Cox proportional hazard models were used to nest patients within residential neighborhoods (census tract) and were controlled for race/ethnicity, age, diagnosis year, tumor stage, grade, histology, neighborhood poverty, and county-level mammography availability. Greater black segregation and Hispanic segregation were adversely associated with cause-specific mortality and all-cause mortality. For example, in adjusted models, Hispanic segregation was associated with cause-specific mortality (adjusted hazard ratio, 1.24; 95% confidence interval, 1.05-1.46). Compared with whites, blacks had higher mortality for both outcomes, whereas Hispanics demonstrated equivalent (cause-specific) or lower (all-cause) mortality. Segregation did not explain racial/ethnic disparities in mortality. Within each race/ethnicity strata, segregation was either adversely associated with mortality or was not significant. Among urban women with breast cancer in Texas, segregation has an independent, adverse association with mortality, and the effect of segregation varies by patient race/ethnicity. The novel application of a small-area measure of relative racial segregation should be examined in other cancer types with documented racial/ethnic disparities across varied geographic areas. Cancer 2015. © 2015 American Cancer Society. © 2015 American Cancer Society.Cancer 02/2015; · 5.20 Impact Factor