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The Racial Disparity in Breast Cancer Mortality

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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.

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References

  1. Ries, L., Eisner, M., & Kosary, M. (2003). SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Institute.

    Google Scholar 

  2. Hirschman, J., Whitman, S., & Ansell, D. (2007). The black: White disparity in breast cancer mortality: The example of Chicago. Cancer Causes and Control, 18, 323–333.

    Article  PubMed  Google Scholar 

  3. Brawley, O. W. (2002). Disaggregating the effects of race and poverty on breast cancer outcomes. Journal of the National Cancer Institute, 94, 471–473.

    PubMed  Google Scholar 

  4. Olopade, O. I., Fackenthal, J. D., Dunston, G., et al. (2002). Breast cancer genetics in African Americans. Cancer, 97, 236–245.

    Article  Google Scholar 

  5. Cunningham, J. E., & Butler, W. M. (2004). Racial disparities in female breast cancer in South Carolina: Clinical evidence for a biological basis. Breast Cancer Research and Treatment, 88, 161–176.

    Article  PubMed  Google Scholar 

  6. Woodward, A. W., Huang, E. H., McNeese, M. D., et al. (2006). African-American race is associated with a poorer overall survival rate for breast cancer patients treated with mastectomy and Doxorubicin-based chemotherapy. Cancer, 107, 2662–2668.

    Article  PubMed  Google Scholar 

  7. Carey, L. A., Perou, C. M., Livasy, C. A., et al. (2006). Race, breast cancer subtypes and survival in the Carolina breast cancer study. JAMA, 295, 2492–2502.

    Article  PubMed  CAS  Google Scholar 

  8. Albain, K. S., Unger, J. M., Crowley, J. J., Coltman, C. A., & Hershman, D. L. (2009). Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. Journal of the National Cancer Institute, 101, 984–992.

    Article  PubMed  Google Scholar 

  9. Anderson, R. N., Minino, A. M., Hoyert, D. L., & Rosenberg, H. M. (2001). Comparability of cause of death between ICD-9 and ICD-10: Preliminary estimates. National Vital Statistics Reports, 49(2), 1–32.

    Google Scholar 

  10. U.S. Census Bureau. (2005). American Community Survey. http://factfinder.census.gov/servlet/DatasetMainPageServlet?_program=ACS&_submenuId=&_lang=en&_ts=.

  11. Keppel, K. G., Pearcy, J. N., & Klein, R. J. (2010). Measuring progress in healthy people 2010. Healthy People 2010 Statical Notes, 2004(25), 1–16.

    Google Scholar 

  12. Kim, H. J., Fay, M. P., Feuer, E. J., & Midthune, D. N. (2000). Permutations tests for joinpoint regression with applications to cancer rates. Statistics in Medicine, 19, 335–351. (correction, 2001;20:655).

    Article  PubMed  CAS  Google Scholar 

  13. Jones, B. A., Patterson, E. A., & Calvocoressi, L. (2003). Mammography screening in African American women: Evaluating the research. Cancer, 97(1 Suppl), 981–985.

    Google Scholar 

  14. Berry, D. A., Cronin, K. A., Plevritis, S. K., et al. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353, 1784–1792.

    Article  PubMed  CAS  Google Scholar 

  15. Chu, Q. D., Smith, M. H., Williams, M., et al. (2009). Race/ethnicity has no effect on outcome for breast cancer patients treated at an academic center with a public hospital. Cancer Epidemiology, Biomarkers and Prevention, 18(8), 2157–2161.

    Article  PubMed  Google Scholar 

  16. Tehranifar, P., Neugut, A. I., Phelen, J. C., Link, B. G., Liao, Y., Desai, M., et al. (2009). Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiology, Biomarkers and Prevention, 18(10), 2701–2708.

    PubMed  Google Scholar 

  17. Centers for Disease Control and Prevention. (2005). Breast cancer screening and socioeconomic status—35 metropolitan areas, 2000 and 2002. MMWR. Morbidity and Mortality Weekly Report, 54, 981–985.

    Google Scholar 

  18. Whitman, S., Shah, A. M., Silva, A., & Ansell, D. (2007). Mammography screening in six diverse communities in Chicago-a population study. Cancer Detection and Prevention, 31, 166–172.

    Article  PubMed  Google Scholar 

  19. Smith-Bindman, R., Miglioretti, D. L., Lurie, N., et al. (2006). Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Annals of Internal Medicine, 144, 541–553.

    PubMed  Google Scholar 

  20. Kagay, C. R., Quale, C., & Smith-Bindman, R. (2006). Screening mammography in the American elderly. American Journal of Preventive Medicine, 31, 142–149.

    Article  PubMed  Google Scholar 

  21. Rauscher, G. H., Johnson, T. P., Cho, T. I., & Walk, J. A. (2008). Accuracy of self-reported cancer screening histories: A meta-analysis. Cancer Epidemiology, Biomarkers and Prevention, 17, 748–757.

    Article  PubMed  Google Scholar 

  22. Olivotto, I. A., Gomi, A., Bancej, C., et al. (2002). Influence of delay to diagnosis on prognostic indicators of screen-detected breast carcinoma. Cancer, 94, 2143–2150.

    Article  PubMed  Google Scholar 

  23. American College of Radiology (ACR). (2003). Breast imaging reporting and data system (BI-RADS) (4th ed.). Reston, VA: American College of Radiology.

    Google Scholar 

  24. Rosenberg, R. D., Yankaskas, B. C., Abraham, L. A., et al. (2006). Performance benchmarks for screening mammography. Radiology, 24, 55–66.

    Article  Google Scholar 

  25. May, D. S., Lee, N. C., Richardson, L. C., Giustozzi, A. G., & Bobo, J. K. (2000). Mammography and breast cancer detection by race and hispanic ethnicity: Results from a national program (United States). Cancer Causes and Control, 11, 697–705.

    Article  PubMed  CAS  Google Scholar 

  26. Wang, H., Karesen, R., Hervik, A., & Thoresen, S. O. (2001). Mammography screening in Norway: Results from the first screening round in four countries and cost-effectiveness of a modeled nationwide screening. Cancer Causes and Control, 12, 39–45.

    Article  PubMed  CAS  Google Scholar 

  27. Sickles, E. A., Wolverton, D. E., & Dee, K. E. (2002). Performance parameters for screening and diagnostic mammography: Specialist and general radiologists. Radiology, 224, 861–869.

    Article  PubMed  Google Scholar 

  28. Ryerson, A. B., Bernard, V. B., & Major, A. C. (2005). National breast and cervical cancer early detection program: 1991–2002 national report. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control.

    Google Scholar 

  29. Moss, M., & Steinhauer, J. (2002). Mammogram clinic’s flaws highlight gaps in US rules. The New York Times, A1.

  30. Centers for Disease Control and Prevention. (2004). Breast cancer-screening data for assessing quality of services—New York, 2000–2003. MMWR. Morbidity and Mortality Weekly Report, 53(21), 445–457.

    Google Scholar 

  31. Miglioretti, D. L., Smith-Bindman, R., Abraham, L., et al. (2007). Radiologist characteristics associated with interpretive performance of diagnostic mammography. Journal of National Cancer Institute, 99, 1854–1863.

    Article  Google Scholar 

  32. Jones, B. A., Kasl, S. V., Culler, C. S., et al. (2001). Is variation in quality of mammographic services race linked?. Journal of Health Care for the Poor and Underserved, 12, 113–126.

    PubMed  CAS  Google Scholar 

  33. Smith-Bindman, R., Chu, P., Miglioretti, D. L., et al. (2005). Physician predictors of mammographic accuracy. Journal of the National Cancer Institute, 97, 358–367.

    Article  PubMed  Google Scholar 

  34. Institute of Medicine and National Research Council. (2005). Improving breast imaging quality standards. Washington, DC: The National Academies Press. See especially Chapter 2.

    Google Scholar 

  35. Barlow, W. E., Chi, C., Carney, P. A., et al. (2002). Accuracy of screening mammography interpretation by characteristics of radiologists. Journal of the National Cancer Institute, 94, 1546–1554.

    PubMed  Google Scholar 

  36. Miglioretti, D. L., Smith-Bindman, R., Abraham, R., et al. (2007). Radiologist characteristics associated with interpretive performance of diagnostic mammography. Journal of the National Cancer Institute, 99, 1854–1863.

    Article  PubMed  Google Scholar 

  37. Hirschman, J., Whitman, S., Ansell, D., Grabler, P., Allgood, K. 2006. Breast cancer in Chicago: Eliminating disparity and improving mammography quality. Chicago, IL: Sinai Urban Health Institute. http://www.suhichicago.org/files/publications/G.pdf. Accessed 2 November 2010.

  38. Kerner, J. F., Yedidia, M., Padget, D., et al. (2003). Realizing the promise of breast cancer screening: Clinical follow-up after abnormal screening among black women. Preventive Medicine, 37, 92–101.

    Article  PubMed  Google Scholar 

  39. Elmore, J. G., Nakano, C. Y., Linden, H. M., Reisch, L. M., Ayanian, J. A., & Larson, E. B. (2005). Racial inequities in the timing of breast cancer detection, diagnosis, and initiation of treatment. Medical Care, 43(2), 141–148.

    Article  PubMed  Google Scholar 

  40. Jones, B. A., Reams, K., Calvocoressi, L., Dailey, A., Kasl, S. V., & Liston, N. M. (2007). Adequacy of communicating results from screening mammograms to African American and white women. American Journal of Public Health, 97(3), 531–538.

    Article  PubMed  Google Scholar 

  41. Smedley, B. D., Stih, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.

    Google Scholar 

  42. Epstein, A. M., Ayanian, J. Z., Keogh, J. H., et al. (2000). Racial disparities in access to renal transplantation. New England Journal of Medicine, 343, 1537–1544.

    Article  PubMed  CAS  Google Scholar 

  43. Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., & Ayanian, J. Z. (2006). Relationship between quality of care and racial disparities in medicare health plans. JAMA, 296, 1998–2004.

    Article  PubMed  CAS  Google Scholar 

  44. Gross, C. P., Smith, B. D., Wolf, E., & Andersen, M. (2008). Racial disparities in cancer therapy: Did the gap narrow between 1992 and 2002? Cancer, 112, 900–908.

    Article  PubMed  Google Scholar 

  45. Li, C. I., Malone, K. E., & Daling, J. R. (2003). Differences in breast cancer stage, treatment, and survival by race and ethnicity. Archives of Internal Medicine, 163, 49–56.

    Article  PubMed  Google Scholar 

  46. Gorin, S. S., Heck, J. E., Cheng, B., et al. (2006). Delays in breast cancer diagnosis and treatment by racial/ethnic group. Archives of Internal Medicine, 166, 2244–2252.

    Article  PubMed  Google Scholar 

  47. Schleinitz, M. D., DePalo, D., Blume, J., & Stein, M. (2006). Can differences in breast cancer utilities explain disparities in breast cancer care? Journal of General Internal Medicine, 21(12), 1253–1260.

    Article  PubMed  Google Scholar 

  48. Breen, N., Wesley, M. N., Merrill, R. M., et al. (1999). The relationship of socio-economic status and access to minimum expected therapy among female breast cancer patients in the National Cancer Institute Black-White cancer survival study. Ethnicity and Disease, 9, 111–125.

    PubMed  Google Scholar 

  49. Institute of Medicine. (2006). Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st Century. Washington, DC: National Academy Press.

    Google Scholar 

  50. Ansell, D., Grabler, P., Whitman, S., et al. (2009). A community effort to reduce the black/white breast cancer mortality disparity in Chicago. Cancer Causes and Control. Published online: 18 August 2009.

  51. Chlebowski, R. T., Chen, Z., Anderson, G. L., et al. (2005). Ethnicity and breast cancer: Factors influencing differences in incidence and outcome. Journal of the National Cancer Institute, 97, 439–448.

    Article  PubMed  Google Scholar 

  52. Curtis, E., Quale, C., & Haggstrom, D. (2008). Racial and ethnic differences in breast cancer survival. Cancer, 112, 171–180.

    Article  PubMed  Google Scholar 

  53. Freeman, H. P. (1998). The meaning of race in science–considerations for cancer research. Cancer, 82, 219–225.

    Article  PubMed  CAS  Google Scholar 

  54. Hunt, L. M., & Megyesi, M. S. (2008). The ambiguous meanings of the racial/ethnic categories routinely used in human genetics research. Social Science and Medicine, 66, 349–361.

    Article  PubMed  Google Scholar 

  55. Duster, T. (2003). Backdoor to eugenics (2nd ed.). New York, NY: Routledge Press.

    Book  Google Scholar 

  56. Allen, T. W. (1997). The Invention of the White Race. New York, NY: Verso Press.

    Google Scholar 

  57. Kaufman, J. S., Cooper, R. S., & McGhee, D. L. (1997). Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiology, 8, 621–628.

    Article  PubMed  CAS  Google Scholar 

  58. Krieger, N., Chen, J. T., & Waterman, P. D. (2010). Decline in US breast cancer rates after the women’s health initiative: Socioeconomic and racial/ethnic differentials. American Journal of Public Health, 100, S132–S139.

    Article  PubMed  Google Scholar 

  59. McClintock, M. K., Conzen, S. D., Gehlert, S., Masi, C., & Olopade, F. (2005). Mammary cancer and social interactions: identifying multiple environments that regulate gene expression throughout the life span. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60, 32–41.

    Article  Google Scholar 

  60. Sankar, P. S., Cho, M. K., Condit, C. M., et al. (2004). Genetic research and health disparities. JAMA, 291, 2985–2989.

    Article  PubMed  CAS  Google Scholar 

  61. Cooper, R. S., Kaufman, J. S., & Ward, R. (2003). Race and genomics. New England Journal of Medicine, 348(12), 1166–1170.

    Article  PubMed  Google Scholar 

  62. Jones, J. (1993). Bad blood. New York, NY: Free Press.

    Google Scholar 

  63. Brawley, O. W., & Freeman, H. P. (1999). Race and outcomes: Is this the end of the beginning for minority health research? Journal of the National Cancer Institute, 9, 1433–1440.

    Google Scholar 

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Acknowledgment

The authors would like to thank the Avon Breast Cancer Foundation (grant #05-2010-075) for its generous support of this research and other efforts to eliminate disparities in breast cancer mortality in Chicago.

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Correspondence to Steven Whitman.

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Whitman, S., Ansell, D., Orsi, J. et al. The Racial Disparity in Breast Cancer Mortality. J Community Health 36, 588–596 (2011). https://doi.org/10.1007/s10900-010-9346-2

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