The racial disparity in breast cancer mortality

Sinai Urban Health Institute, Room K437, 1500 S. California Avenue, Chicago, IL 60608, USA.
Journal of Community Health (Impact Factor: 1.28). 12/2010; 36(4):588-96. DOI: 10.1007/s10900-010-9346-2
Source: PubMed

ABSTRACT Black women die of breast cancer at a much higher rate than white women. Recent studies have suggested that this racial disparity might be even greater in Chicago than the country as a whole. When data describing this racial disparity are presented they are sometimes attributed in part to racial differences in tumor biology. Vital records data were employed to calculate age-adjusted breast cancer mortality rates for women in Chicago, New York City and the United States from 1980-2005. Race-specific rate ratios were used to measure the disparity in breast cancer mortality. Breast cancer mortality rates by race are the main outcome. In all three geographies the rate ratios were approximately equal in 1980 and stayed that way until the early 1990s, when the white rates started to decline while the black rates remained rather constant. By 2005 the black:white rate ratio was 1.36 in NYC, 1.38 in the US, and 1.98 in Chicago. In any number of ways these data are inconsistent with the notion that the disparity in black:white breast cancer mortality rates is a function of differential biology. Three societal hypotheses are posited that may explain this disparity. All three are actionable, beginning today.

    • "Most previous studies on cancer disparities in NYC as well as other locations have focused on race/ethnicity (Mayberry et al., 1995; Cruz et al., 2007; Hirschman et al., 2007; Jandorf et al., 2008; Whitman et al., 2011). For studies that attempted to disentangle the effects of SES disparities as well as race/ethnicity, only single cancer sites have been investigated to date (McCarthy et al., 2010; Richards et al., 2011; Whitman et al., 2011). Different population studies have observed that living in SES-deprived neighborhoods was associated independently with lifestyle health risks, such as excess body weight (Janssen et al., 2006; Mobley et al., 2006), tobacco smoking (Hanibuchi et al., 2014), lower physical activity (Van Lenthe et al., 2005), increased stress (Cheng et al., 2014), and lower fruit and vegetable consumption (Giskes et al., 2006; Dubowitz et al., 2008). "
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    ABSTRACT: We examined the effects of race/ethnicity and neighborhood, a proxy of socioeconomic status, on cancer incidence in New York City neighborhoods: East Harlem (EH), Central Harlem (CH), and Upper East Side (UES). In this ecological study, Community Health Survey data (2002-2006) and New York State Cancer Registry incidence data (2007-2011) were stratified by sex, age, race/ethnicity, and neighborhood. Logistic regression models were fitted to each cancer incidence rate with race/ethnicity, neighborhood, and Community Health Survey-derived risk factors as predictor variables. Neighborhood was significantly associated with all cancers and 14 out of 25 major cancers. EH and CH residence conferred a higher risk of all cancers compared with UES (OR=1.34, 95% CI 1.07-1.68; and OR=1.39, 95% CI 1.12-1.72, respectively). The prevalence of diabetes and tobacco smoking were the largest contributors toward high cancer rates. Despite juxtaposition and similar proximity to medical centers, cancer incidence disparities persist among EH, CH, and UES neighborhoods. Targeted, neighborhood-specific outreach may aid in reducing cancer incidence rates.
    European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 07/2015; DOI:10.1097/CEJ.0000000000000180 · 2.76 Impact Factor
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    • "Despite numerous papers that attribute this disparity to genetics [10] [11] [12], our data suggest that this cannot be the case. In fact, in a previous paper [3] we traced the racial disparity in breast cancer mortality back to 1980 for Chicago, New York City, and the U.S. and found smaller disparities at that time than even the small ones that existed in the current analysis for 1990–1994. 4.1. "
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    ABSTRACT: Introduction: This paper presents race-specific breast cancer mortality rates and the corresponding rate ratios for the 50 largest U.S. cities for each of the 5-year intervals between 1990 and 2009. Methods: The 50 largest cities in the U.S. were the units of analysis. Numerator data were abstracted from national death files where the cause was malignant neoplasm of the breast (ICD-9=174 and ICD-10=C50) for women. Population-based denominators were obtained from the U.S. Census Bureau for 1990, 2000, and 2010. To measure the racial disparity, we calculated non-Hispanic Black:non-Hispanic White rate ratios (RRs) and confidence intervals for each 5-year period. Results: At the final time point (2005-2009), two RRs were less than 1, but neither significantly so, while 39 RRs were >1, 23 of them significantly so. Of the 41 cities included in the analysis, 35 saw an increase in the Black:White RR between 1990-1994 and 2005-2009. In many of the cities, the increase in the disparity occurred because White rates improved substantially over the 20-year study period, while Black rates did not. There were 1710 excess Black deaths annually due to this disparity in breast cancer mortality, for an average of about 5 each day. Conclusion: This analysis revealed large and growing disparities in Black:White breast cancer mortality in the U.S. and many of its largest cities during the period 1990-2009. Much work remains to achieve equality in breast cancer mortality outcomes.
    02/2014; 38(2). DOI:10.1016/j.canep.2013.09.009
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    • "Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program indicate that age-adjusted breast cancer incidence rates in African Americans are substantially lower than those from Caucasian women with 141 cases per 100 000 in Caucasian women and 122 in African Americans [6] [7]. Although the incidence may be lower in AAs, the mortality rate appears to be higher compared to Caucasian women [8] [9] [10]. Numerous studies have proposed several theories to account for the racial differences in survival. "
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    ABSTRACT: Breast cancer survival has significantly improved over the past two decades. However, the diagnosis of breast cancer is lower and the mortality rate remains higher, in African American women (AA) compared to Caucasian-American women. The purpose of this investigation is to analyze postoperative events that may affect breast cancer survival. This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center cancer registry from 1997 to 2010. Of the 1538 patients in the registry, 1226 are AA and 269 are Caucasian. The study was divided into two time periods, 1997-2004 (period A) and 2005-2010 (period B), in order to assess the effect of treatment outcomes on survival. During period A, 5-year survival probabilities of 75.37%, 74.53%, and 78.70% were seen among all patients, AA women and Caucasian women, respectively. These probabilities increased to 87.62%, 87.15% and 89.99% in period B. Improved survival in AA women may be attributed to the use of adjuvant chemotherapy, radiation, and hormonal therapy. Improved survival in Caucasian patients was attributed to the use of radiation therapy, as well as earlier detection resulting in more favorable tumor grades and pathological stages.
    02/2014; 2014:694591. DOI:10.1155/2014/694591
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