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


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.

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    • "Although the advent of screening tools such as mammograms and increased public awareness surrounding breast cancer have significantly reduced the mortality associated with this disease, significant disparities in outcomes still exist [2]. Specifically, the literature has demonstrated differences in stage at diagnosis, types of treatment available, and outcomes by primary language, race, insurance type, marital status, and other demographic factors [2] [3] [4]. "
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    ABSTRACT: Objective . To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center. Patients and Methods . 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012. Results . There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37, p = 0.006 ), age > 70 years (OR = 3.88, CI = 1.13–11.48, p = 0.014 ), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06, p < 0.0001 ). Conclusions . In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.
    Full-text · Article · Nov 2015
    • "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.
    No preview · Article · Jul 2015 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
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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.
    Full-text · Article · Feb 2014
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