Race, ethnicity, and disparities in breast cancer: victories and challenges

Abstract

Breast cancer is a disease for which early detection and treatment can improve survival. It is a disease for which access to care, patient attitudes and beliefs about cancer, physician attitudes and beliefs, as well as health care delivery systems’ organization can affect a woman’s risk of dying from breast cancer. 1 Ayanian J.Z. Kohler B.A. Abe T. Epstein A.M. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993; 329: 326-331 Crossref PubMed Scopus (540) Google Scholar , 2 Perez-Stable E.J. Sabogal F. Otero-Sabogal Hiatt R.A. McPhee S.J. Misconceptions about cancer among Latinos and Anglos. JAMA. 1992; 268: 3219-3223 Crossref PubMed Scopus (255) Google Scholar , 3 Lannin D.R. Mathews H.F. Mitchell J. Swanson M.S. Swanson F.H. Edwards M.S. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998; 279: 1801-1807 Crossref PubMed Scopus (506) Google Scholar , 4 Bickell N.A. McEvoy M.D. Chassin M.R. Reasons for underuse the case of breast cancer. JGIM. 2000; 15: 103 PubMed Google Scholar , 5 Siminoff L.A. Zhang A. Saunders Sturm C.M. Colabianchi N. Referral of breast cancer patients to medical oncologists after initial surgical management. Med Care. 2000; 38: 696-704 Crossref PubMed Scopus (36) Google Scholar , 6 Burns R.B. Freund K.M. Moskowitz M.A. Kasten L. Feldman H. McKinlay J.B. Physician characteristics Do they influence the evaluation and treatment of breast cancer in older women?. Am J Med. 1997; 103: 263-269 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar , 7 Liberati A. Patterson W.B. Biener L. McNeil B.J. Determinants of physicians’ preferences for alternative treatments in women with early breast cancer. Tumori. 1987; 73: 601-609 PubMed Google Scholar , 8 Lazovich D.A. White E. Thomas D.B. Moe R.E. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA. 1991; 266: 3433-3438 Crossref PubMed Scopus (348) Google Scholar , 9 Lazovich D. White E. Thomas D.B. Moe R.E. Taplin S. Change in the use of breast conserving surgery in western Washington after the 1990 NIH Consensus Development Conference. Arch Surg. 1997; 132: 418-423 Crossref PubMed Scopus (33) Google Scholar , 10 Lee-Feldstein A. Anton-Culver H. Feldstein P.J. Treatment differences and other prognostic factors related to breast cancer survival delivery systems and medical outcomes. JAMA. 1994; 271: 1163-1168 Crossref PubMed Scopus (159) Google Scholar , 11 Bickell N.A. Young G.J. Coordination of care for early-stage breast cancer patients. J Gen Intern Med. 2001; 16: 737-742 Crossref PubMed Google Scholar , 12 Hand R. Saner S. Imperator J. Knawel J.C. Sylvester J.A. Fremgen A. Hospital variables associated with quality of care for breast cancer patients. JAMA. 1991; 266: 3429-3432 Crossref PubMed Scopus (103) Google Scholar For years, black women were less likely to get screening mammograms, more likely to present with later stage cancer, and less likely to get adjuvant treatments, so it was no surprise that they were more likely to die of breast cancer. Given this history, there was great excitement surrounding the release of this year’s national cancer statistics. Breast cancer death rates, on the decline among white women for the past several years, are starting to go down among black women as well. The increases in incident breast cancer cases seen in both black and white women are limited to the early-stage cancers; those stages with better prognoses and usually detected through screening efforts. Recent national survey data report increasing rates of mammography among all racial groups with whites, blacks, and Asians undergoing mammography at similar rates. 13 Blackman D.K. Bennet D.M. Miller D.S. Trends in self-reported use of mammograms (1989–1997) and Papanicolaou tests (1991–1997)—Behavioral Risk Factor Surveillance System. MMWR. 1999; 48: 1-13 Google Scholar , 14 Breen N. Wagener D.K. Brown M.L. Davis W.W. Ballard-Barbash R. Progress in cancer screening over a decade results of cancer screening from the 1987, 1992, and 1998 national Health Interview Surveys. J Natl Cancer Inst. 2001; 93: 1704-1713 Crossref PubMed Scopus (448) Google Scholar For more than a decade, there has been a national effort to reduce underuse of mammography and increase breast cancer screening among minority, poor, and elderly women; women at higher risk of death from breast cancer. It appears that national and local efforts to improve mammography screening rates may be succeeding in reducing racial disparities in screening and mortality from breast cancer. What are the lessons to be learned from the breast cancer story about reducing racial and ethnic disparities? What can be done to meet the 1998 presidential initiative to eliminate racial and ethnic disparities in cancer by the year 2010?