Cancer In Black Women Research Articles

Breast cancer in black women.

To review the current knowledge about breast cancer in black women--including epidemiology, risk factors, screening practices, pathology, clinical manifestations, treatment, and outcome--with emphasis on issues that might explain why the survival rate in this population of women is lower than that in white women. The MEDLINE database from 1966 to 1995 and the bibliographies of all related articles. Review articles and clinical studies related to all aspects of breast cancer in black women. The incidence of breast cancer is lower in black women (95.8 cases per 100 000 women) than in white women (112.7 cases per 100 000 women). Differences in reproductive factors may partially explain the lower risk for breast cancer among black women in the United States. Breast tumors in black women are consistently diagnosed at a more advanced stage of disease: Forty-two percent of black women present with cancer confined to the breast compared with 53% of white women. In addition, the cancers of black women tend to be more poorly differentiated and are less likely to be estrogen receptor positive. Treatment of breast cancer in black women appears to be similar to that in white women, but little is known about systemic therapy choices and efficacy. Overall, despite their lower risk for breast cancer, black women have a mortality rate from breast cancer similar to that of white women because they have a lower 5-year disease-specific survival rate (64% in black women compared with 80% in white women). The discrepancy in survival rate between black and white women exists because black women have tumors that are more advanced at the time of diagnosis, because tumor biology in black women is different from that in white women (in particular, black women have a higher frequency of poorly differentiated tumors and a lower frequency of hormone receptor-positive tumors), and because of confounding comorbid conditions and socioeconomic factors. Current efforts to improve survival rates in black women with breast cancer should focus on community education, screening efforts, and early detection. As more information is gained about breast cancer treatment in black women, this may also be an important area for intervention.

Undetected Breast Cancer in Black Women

335 Brief communication UNDETECTED BREAST CANCER IN BLACK WOMEN TOTHEeditor: Whileearlydetectionprogramssuccessfullyreducemortality from breast cancer, I found in a recent examination of breast cancer programs in Illinois that many women do not have adequate access to such services. I urge health planners throughout the nation to examine access to breast cancer programs in their states. In the United States, breast cancer leads all other cancers in incidence (28 percent of all cancers in women) and is the second leading cause of cancer death.1 Each year in Illinois, there are an estimated 6,700 new cases of breast cancer, and 2,100 deaths due to breast cancer.2 For black women, breast cancer leads all other causes of cancer mortality .2,5 The survival rates for breast cancer in black women of all ages are approximately 12 percent lower than in white women3, although the incidence of breast cancer is lower among black women in the over-40 age group.3-4 The lower survival rate has been attributed to delays in treatment6, socioeconomic disparity between blacks and whites7, inadequate access by black women to screening5, and different characteristics of tumors.9 Screening and early detection have successfully reduced mortality.10"12 In Illinois as elsewhere, it is likely that early detection programs that stress the importance of breast self-examination (BSE), clinical breast examination, and mammography could reduce deaths due to breast cancer. In addition, programs targeted specifically for black women could narrow the difference in mortality rates between white and black women. Breast cancer detection services are available to many Illinois women. As of January 1,1991, Medicaid in Illinois will pay for a baseline mammogram for women age 35 to 39, screening mammography every one or two years for women age 40 to 49, and yearly screening mammography for women over 50 (Illinois Dept. of Public Aid, personal communication). Medicare will pay for a mammogram only if there is evidence of disease (Health Care Financing Administration, personal communication). Illinois Public Act 86-0899, enacted January 1,1990, requires every provider of group or individual health insurance, including health maintenance organizations, to provide coverage for Journal of Health Care for the Poor and Underserved, Vol. 2, No. 3, Winter 1991 336__________________________________________________________ mammography, using the same guidelines as Medicaid for frequency of mammogram with age (Illinois Dept. of Insurance, personal communication). But women who are neither insured nor eligible for Medicaid must pay at least $50 out-of-pocket for a mammogram. These women often rely on public health departments for assistance. A telephone survey of 18 county and local health departments in Illinois revealed that mammography is available to health department patients in only one area of Illinois—the Englewood neighborhood of Chicago. When asked, all of the departments surveyed cited lack of funding as the major barrier to providing services. Local health departments receive an average of 10 requests for mammography screening each year and usually refer patients to hospitals, local clinics, and private providers who accept Medicaid. When local health departments were asked if they would like to receive more information on funding for mammography, every department responded affirmatively. The Centers for Disease Control (CDC) will grant $13.5 million in 1991 to five state health departments for breast cancer screening of low-income women (Centers for Disease Control, personal communication). Dr. Robert Smith of CDC has stated that funding is "expected to ultimately be given to all 50 states." The Illinois Department of Public Health (IDPH) is applying for one of these contracts. IDPH plans to add mammography to its computerized follow-up system in Chicago and to administer the remaining funds through the Division of Family Health within the Office of Health Services. In turn, the Division of Family Health will request proposals from local health departments for consideration for funding (M. Mattuck, personal communication). In order to significantly improve women's health, public health leaders must examine the need for early detection and treatment of breast cancer. Programs should focus on providing mammography for the women who fall through the cracks of the present system—those who lack health insurance and who are not eligible for Medicaid. In addition, educational programs stressing the importance...

Cancer mortality in a higher-income black population in New York state. Comparison with rates in the United States as a whole

In the 1980 Census the median family income among blacks in Suffolk County, New York (i.e., $19,604) was much higher than that for American blacks as a whole (i.e., $12,618) and 94.1% of that for American whites (i.e., $20,840), but the proportion below the poverty level was still higher for Suffolk County blacks than for American whites. Observed numbers of deaths from 1979 to 1985 for total cancers and most cancer sites in Suffolk County black men and women were not lower than expected on the basis of age-specific and gender-specific death rates for blacks in the US. Although numbers of deaths from cervical cancer and prostate cancer were slightly lower than expected in Suffolk County blacks versus American blacks, these numbers were still significantly greater than expected on the basis of death rates among American whites. Age-specific death rates for age groups 25 to 44 years to 55 to 64 years tended to be lower in Suffolk County for lung cancers in black men but not for breast cancer in black women. Specific cancer sites, which differ in the direction of the association between incidence and socioeconomic status, age, and gender must be considered in comparisons of cancer mortality by race and socioeconomic level. Implications of the comparisons were discussed with regard to the goal of reducing racial differences in cancer death rates.

Mammographic parenchymal patterns and quantitative evaluation of mammographic densities: a case-control study.

The classification of breast parenchymal patterns (N1, P1, P2, DY) and the percentage of the breast containing radiographic densities are two highly correlated radiographic measures proposed as predictors of the risk of breast cancer. In this case-control study, 160 cases of breast cancer and 160 matched controls from a mammography referral practice were compared to determine the risk of breast cancer associated with each of these two radiographic measures. The mammographic densities were quantified on caudal projections by means of a compensating polar planimeter. A relative risk estimate of 3.3 (p less than .05) was associated with the P2 + DY patterns compared with the N1 + P1 patterns. Significantly elevated risks of 4.3 to 5.5 also were observed among women whose breasts contained at least 25% mammographic densities, compared with women with less than 25% involvement. These radiographic measures tended to be more predictive of the risk of breast cancer in black women than in white women. Although the precise clinical roles of breast parenchymal patterns and densities have not been defined fully, the results of this study suggest that they are useful in the recognition of women at high risk of breast cancer. We make no claims that the findings of this study are sufficiently developed to be used as a basis for screening strategies.

Risk Factors for Breast Cancer in Black Women<xref ref-type="fn" rid="FN2">2</xref>

Risk factors for breast cancer were examined in black women in a hospital-based case-control study of 529 black women with breast cancer and 589 controls. Late age at menarche was associated with a reduced risk of breast cancer. Women having 5 or more children had a reduced risk relative to that of women with fewer or no children. Late age at first birth was associated with an elevated risk of breast cancer. Among postmenopausal black women, obesity [as measured by body mass index (BMI)] was associated with an increased risk; among premenopausal women, there was no association of breast cancer with BMI. Women whose menopause occurred at or after age 50 were at increased risk relative to those whose menopause occurred earlier. There was no association between number of years of education and breast cancer in black women. History of benign breast disease and history of breast cancer in mother or sisters both were risk factors. The risk factor profile for breast cancer in black women was similar to that observed in whites.

Low survival of South African urban black women with cervical cancer.

In Soweto, Johannesburg, the incidence of cervical cancer, the most common cancer in black women, is higher than in most white populations but lower than in many other populations. In a series of 210 patients who were diagnosed in 1981 and 1982, 50% had died within 1.6 years of diagnosis, a third of the reported survival time in white patients. The pattern of stage at presentation was similar to, although sometimes later than, those reported for various white communities. Data on patients' age at birth of first child, parity, smoking practice, and socioeconomic status, differed little from those in a control group. Neither these factors, nor availability of medical services, could be correlated with the distressingly short period of survival, which also occurs among urban black patients with breast and oesophageal cancers. Presumably, unidentified factors linked with low socioeconomic status affect survival time.

Breast cancer in black women.

Breast cancer in black women.

Cancer of the Breast

IN THE Third National Cancer Survey (1969 to 1971), cancer of the breast was found to make up 27.5% of all cancer in white women and 23% of all cancer in black women.¹In 1975 an estimated 88,700 new cases of cancer of the breast occurred in the United States; the risk, low for women younger than 25 years of age, rises thereafter and never declines, so that the older the patient, the greater her chance of having cancer of the breast. Progress made in this century in the diagnosis and treatment of malignant tumors has brought about a reduction in the mortality from some major forms of cancer: carcinoma of the cervix stands as a notable example. However, despite earlier diagnosis, reduced operative mortality, and the development of surgical adjuvants, there has been no reduction in the mortality from cancer of the breast. In the United States, the