Abstract
Racial disparities in breast cancer present a vexing and complex challenge for public health. A diverse array of factors contributes to disparities in breast cancer incidence and outcomes, and, thus far, efforts to improve racial equity have yielded mixed results. Systems theory offers a model that is well-suited to addressing complex issues. In particular, the concept of a systemic leverage point offers a clue that may assist researchers, policymakers, and interventionists in formulating innovative and comprehensive approaches to eliminating racial disparities in breast cancer. Naming systemic racism as a fundamental cause of disparities, we use systems theory to identify residential segregation as a key leverage point and a driver of racial inequities across the social, economic, and environmental determinants of health. We call on researchers, policymakers, and interventionists to use a systems-informed, community-based participatory approach, aimed at harnessing the power of place, to engage directly with community stakeholders in coordinating efforts to prevent breast cancer, and work toward eliminating disparities in communities of color.
Highlights
There are significant racial disparities in breast cancer incidence, care, and outcomes, with Black women experiencing higher incidence of aggressive breast cancer subtypes, lower quality of care, and higher mortality rates than white women [1,2,3]
Given that individual and environmental exposures to breast cancer risk factors are impacted by place of residence, it is plausible that the disparities in incidence, care, and outcomes outlined by Landrine et al are the result of the differential distribution of these exposures between segregated neighborhoods [48]
Reskin gives a broad outline of racial discrimination in American society, and makes a compelling case that each of the subsystems in which disparities exist are connected by the broader system of racism within which they are situated [4]
Summary
There are significant racial disparities in breast cancer incidence, care, and outcomes, with Black women experiencing higher incidence of aggressive breast cancer subtypes, lower quality of care, and higher mortality rates than white women [1,2,3]. These disparities persist despite efforts to eliminate them. With respect to health disparities generally, and breast cancer disparities residential racial segregation is one such leverage point It has historically produced inequities in access to opportunities and resources [7]. In 2012, breast cancer mortality among black women was 42% higher than it was among white women [2]
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