Skip to main content

Advertisement

Log in

Racial/Ethnic Disparities in Breast Cancer Incidence, Risk Factors, Health Care Utilization, and Outcomes in the USA

  • Psycho-Oncology and Supportive Care (E Shinn and C Fagundes, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

This review examines racial/ethnic disparities in female breast cancer within the USA. Specifically, differences in breast cancer incidence, risk factors, health care utilization use, and outcomes among Caucasians and non-Caucasians are explored.

Findings

In the USA, there are striking racial/ethnic disparities for female breast cancer. The etiology of these disparities is likely multi-factorial, including genetic, behavioral, socio-cultural, and environmental elements. Relative to Caucasian women, African American, Hispanic, and Asian/Pacific Islander breast cancer patients generally have a lower survival rate and worse prognosis despite lower incidence rates. They also tend to have more associated health problems and unmet psychosocial needs.

Summary

Breast cancer patients are heterogeneous with respect to their race, cultural background, socioeconomic status, behavioral profile, and disease pathophysiology, and these factors impact health outcomes and health care needs. To reduce disparities and improve health outcomes in minority women, a multifaceted approach is required that includes efforts to minimize barriers to health care access, enhance cancer screening rates, and increase the use of culturally sensitive interventions designed to reduce symptom burden and enhance quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Surveillance Epidemiology and End Results Program (SEER). Statistics at a Glance: Female Breast Cancer. 2016 01/27/17; Available from: https://seer.cancer.gov/statfacts/html/breast.html. Program of the National Cancer Institute (NCI) and significant source of epidemiologic information on the incidence and survivla rates of cancer in the United States.

  2. • National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology. Breast Cancer Screening and Diagnosis. 2016; Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf. An excellent overview of national evidence-based guidelines for breast cancer screening and diagnosis.

  3. American Cancer Society (ACS). Cancer treatment and survivorship. Breast Cancer, 2016.

  4. National Cancer Institute at the National Institutes of Health. Cancer health disparities. 2016 01.31.2017; Available from: https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet-q1.

  5. Samson ME, Porter NG, Hurley DM, Adams SA, Eberth JM. Disparities in breast cancer incidence, mortality, and quality of care among African American and European American women in South Carolina. South Med J. 2016;109(1):24–30.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stern MC, Fejerman L, Das R, Setiawan VW, Cruz-Correa MR, Perez-Stable EJ, Figueiredo JC. Variability in cancer risk and outcomes within US Latinos by national origin and genetic ancestry. Curr Epidemiol Rep. 2016;3:181–90.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Crawford J, Ahmad F, Beaton D, Bierman AS. Cancer screening behaviours among South Asian immigrants in the UK, US and Canada: a scoping study. Health Soc Care Community. 2016;24(2):123–53.

    Article  PubMed  Google Scholar 

  8. • Iqbal J, Ginsburg O, Rochon PA, Sun P, Narod SA. Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA. 2015;313(2):165–73. A thorough review of differences in breast cancer stage at diagnosis and survival stratified by race and ethnicity, including African Americans, Hispanic, and Asian/Pacific Islander BCS.

    Article  CAS  PubMed  Google Scholar 

  9. O'Keefe EB, Meltzer JP, Bethea TN. Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000-2010. Front Public Health. 2015;3:51.

    PubMed  PubMed Central  Google Scholar 

  10. Patel-Kerai G., Harcourt D., Rumsey N., Naqvi H., White P., The psychosocial experiences of breast cancer amongst Black, South Asian and White survivors: do differences exist between ethnic groups? Psychooncology, 2016.

  11. Colby S., Ortman J. Projections of the size and composition of the U.S. population: 2014 to 2060. United States Census Bureau 2015 02/01/2017; Available from: https://www.census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf.

  12. Gonzalez P, Nunez A, Wang-Letzkus M, Lim JW, Flores KF, Napoles AM. Coping with breast cancer: reflections from Chinese American, Korean American, and Mexican American women. Health Psychol. 2016;35(1):19–28.

    Article  PubMed  Google Scholar 

  13. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.

    Article  PubMed  Google Scholar 

  14. Reeder-Hayes KE, Wheeler SB, Mayer DK. Health disparities across the breast cancer continuum. Semin Oncol Nurs. 2015;31(2):170–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. LaVeist TA, Gaskin D, Richard P. Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv. 2011;41(2):231–8.

    Article  PubMed  Google Scholar 

  16. Fagundes C, LeRoy A, Karuga M. Behavioral symptoms after breast cancer treatment: a biobehavioral approach. J Pers Med. 2015;5(3):280–95.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Maly RC, Umezawa Y, Leake B, Silliman RA. Mental health outcomes in older women with breast cancer: impact of perceived family support and adjustment. Psychooncology. 2005;14(7):535–45.

    Article  PubMed  Google Scholar 

  18. Lim JW, Paek MS. Recruiting Chinese- and Korean-Americans in cancer survivorship research: challenges and lessons learned. J Cancer Educ. 2016;31(1):108–14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wen KY, Fang CY, Ma GX. Breast cancer experience and survivorship among Asian Americans: a systematic review. J Cancer Surviv. 2014;8(1):94–107.

    Article  PubMed  Google Scholar 

  20. Ahmad S, Fergus K, McCarthy M. Psychosocial issues experienced by young women with breast cancer: the minority group with the majority of need. Curr Opin Support Palliat Care. 2015;9(3):271–8.

    Article  PubMed  Google Scholar 

  21. Lichter D.T., Parisi D., De Valk H. The Poverty and Inequatliy Report 2016. Residential Segregation. 2016 02/09/2017; Available from: http://inequality.stanford.edu/sites/default/files/Pathways-SOTU-2016-Residential-Segregration-3.pdf.

  22. Blinder VS, Murphy MM, Vahdat LT, Gold HT, de Melo-Martin I, Hayes MK, Scheff RJ, Chuang E, Moore A, Mazumdar M. Employment after a breast cancer diagnosis: a qualitative study of ethnically diverse urban women. J Community Health. 2012;37(4):763–72.

    Article  CAS  PubMed  Google Scholar 

  23. Szalacha L. A., Kue J., Menon U., Knowledge and beliefs regarding breast and cervical cancer screening among Mexican-heritage Latinas. Cancer Nurs, 2016.

  24. Licqurish S, Phillipson L, Chiang P, Walker J, Walter F, Emery J. Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies. Eur J Cancer Care (Engl). 2016;

  25. Freedman RA, Kouri EM, West DW, Keating NL. Racial/ethnic disparities in knowledge about one's breast cancer characteristics. Cancer. 2015;121(5):724–32.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Allford A, Qureshi N, Barwell J, Lewis C, Kai J. What hinders minority ethnic access to cancer genetics services and what may help? Eur J Hum Genet. 2014;22(7):866–74.

    Article  PubMed  Google Scholar 

  27. Smith SA, Claridy MD, Whitehead MS, Sheats JQ, Yoo W, Alema-Mensah E, Ansa BE, Braithwaite RL. Factors associated with body mass index among African American breast cancer survivors. J Ga Public Health Assoc. 2016;5(3):259–65.

    PubMed  PubMed Central  Google Scholar 

  28. Chan DN, So WK. A systematic review of randomised controlled trials examining the effectiveness of breast and cervical cancer screening interventions for ethnic minority women. Eur J Oncol Nurs. 2015;19(5):536–53.

    Article  PubMed  Google Scholar 

  29. Khan HM, Saxena A, Vera V, Abdool-Ghany F, Gabbidon K, Perea N, Stewart TS, Ramamoorthy V. Black Hispanic and black non-Hispanic breast cancer survival data analysis with half-normal model application. Asian Pac J Cancer Prev. 2014;15(21):9453–8.

    Article  PubMed  Google Scholar 

  30. • National Comprehensive Cancer Network (NCCN). Breast cancer risk reduction. NCCN Evidence Blocks. 2016; Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast_risk_blocks.pdf. An excellent overview of national evidence-based guidelines for breast cancer risk reduction.

  31. Sineshaw HM, Gaudet M, Ward EM, Flanders WD, Desantis C, Lin CC, Jemal A. Association of race/ethnicity, socioeconomic status, and breast cancer subtypes in the National Cancer Data Base (2010-2011). Breast Cancer Res Treat. 2014;145(3):753–63.

    Article  PubMed  Google Scholar 

  32. Swede H, Gregorio DI, Tannenbaum SH, Brockmeyer JA, Ambrosone C, Wilson LL, Pensa MA, Gonsalves L, Stevens RG, Runowicz CD. Prevalence and prognostic role of triple-negative breast cancer by race: a surveillance study. Clin Breast Cancer. 2011;11(5):332–41.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wheeler SB, Reeder-Hayes KE, Carey LA. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18(9):986–93.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fejerman L, Stern MC, John EM, Torres-Mejia G, Hines LM, Wolff RK, Baumgartner KB, Giuliano AR, Ziv E, Perez-Stable EJ, Slattery ML. Interaction between common breast cancer susceptibility variants, genetic ancestry, and nongenetic risk factors in Hispanic women. Cancer Epidemiol Biomark Prev. 2015;24(11):1731–8.

    Article  CAS  Google Scholar 

  35. Elewonibi B. R., Thierry A. D., Miranda P. Y., Examining mammography use by breast cancer risk, Race, eNativity, and Socioeconomic Status. J Immigr Minor Health, 2016.

  36. Sheppard VB, Oppong BA, Hampton R, Snead F, Horton S, Hirpa F, Brathwaite EJ, Makambi K, Onyewu S, Boisvert M, Willey S. Disparities in breast cancer surgery delay: the lingering effect of race. Ann Surg Oncol. 2015;22(9):2902–11.

    Article  PubMed  Google Scholar 

  37. Anderson EE, Hoskins K. Individual breast cancer risk assessment in underserved populations: integrating empirical bioethics and health disparities research. J Health Care Poor Underserved. 2012;23(4 Suppl):34–46.

    Article  PubMed  Google Scholar 

  38. Nonzee NJ, Ragas DM, Ha LT, Phisuthikul AM, Tom L, Dong X, Simon MA. Delays in cancer care among low-income minorities despite access. J Women's Health (Larchmt). 2015;24(6):506–14.

    Article  Google Scholar 

  39. Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106(4):751–8.

    Article  PubMed  Google Scholar 

  40. Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C. Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw. 2015;13(8):1012–39.

    Article  Google Scholar 

  41. Ahlberg K, Ekman T, Gaston-Johansson F, Mock V. Assessment and management of cancer-related fatigue in adults. Lancet. 2003;362(9384):640–50.

    Article  PubMed  Google Scholar 

  42. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94(1):39–49.

    Article  PubMed  Google Scholar 

  43. Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH, Miaskowski C, Scherr SL, Portenoy RK, Vogelzang NJ. Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist. 2000;5(5):353–60.

    Article  CAS  PubMed  Google Scholar 

  44. Prue G, Rankin J, Allen J, Gracey J, Cramp F. Cancer-related fatigue: a critical appraisal. Eur J Cancer. 2006;42(7):846–63.

    Article  CAS  PubMed  Google Scholar 

  45. Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18(4):743–53.

    Article  CAS  PubMed  Google Scholar 

  46. Tat S., Doan T., Yoo G. J., Levine E. G., Qualitative exploration of sexual health among diverse breast cancer survivors. J Cancer Educ, 2016.

  47. Nahleh ZA., Dwivedi A., Khang T., Sattar A., Tfayli AH., Farrag S., Mallawaarachchi I., Decreased health related quality of life among hispanic breast cancer survivors. MOJ Womens Health, 2016. 1(3).

  48. • Connor AE, Baumgartner RN, Pinkston CM, Boone SD, Baumgartner KB. Obesity, ethnicity, and quality of life among breast cancer survivors and women without breast cancer: the long-term quality of life follow-up study. Cancer Causes Control. 2016;27(1):115–24. This longitudinal study report the impact of obesity on mental and physical health in a large and ethnically diverse sample of BCS.

    Article  PubMed  Google Scholar 

  49. Ell K, Vourlekis B, Nissly J, Padgett D, Pineda D, Sarabia O, Walther V, Blumenfield S, Lee PJ. Integrating mental health screening and abnormal cancer screening follow-up: an intervention to reach low-income women. Community Ment Health J. 2002;38(4):311–25.

    Article  PubMed  Google Scholar 

  50. Yanez B, Thompson EH, Stanton AL. Quality of life among Latina breast cancer patients: a systematic review of the literature. J Cancer Surviv. 2011;5(2):191–207.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Borstelmann NA, Rosenberg SM, Ruddy KJ, Tamimi RM, Gelber S, Schapira L, Come S, Borges V, Morgan E, Partridge AH. Partner support and anxiety in young women with breast cancer. Psychooncology. 2015;24(12):1679–85.

    Article  PubMed  Google Scholar 

  52. Leung J, Smith MD, McLaughlin D. Inequalities in long term health-related quality of life between partnered and not partnered breast cancer survivors through the mediation effect of social support. Psychooncology. 2016;25(10):1222–8.

    Article  PubMed  Google Scholar 

  53. Chatman MC, Green RD. Addressing the unique psychosocial barriers to breast cancer treatment experienced by African-American women through integrative navigation. J Natl Black Nurses Assoc. 2011;22(2):20–8.

    PubMed  Google Scholar 

  54. Greenlee H, Ogden GA, Aycinena AC, Koch P, Contento I, Karmally W, Richardson JM, Shi Z, Lim E, Tsai WY, Santella RM, Blaner WS, Clugston RD, Cremers S, Pollak S, Sirosh I, Crew KD, Maurer M, Kalinsky K, Hershman DL. Long-term diet and biomarker changes after a short-term intervention among Hispanic breast cancer survivors: the “Cocinar Para Su Salud!” randomized controlled trial. Cancer Epidemiol Biomark Prev. 2016;25(11):1491–502.

    Article  Google Scholar 

  55. Lechner SC, Whitehead NE, Vargas S, Annane DW, Robertson BR, Carver CS, Kobetz E, Antoni MH. Does a community-based stress management intervention affect psychological adaptation among underserved black breast cancer survivors? J Natl Cancer Inst Monogr. 2014;2014(50):315–22.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Sheppard VB, Hicks J, Makambi K, Hurtado-de-Mendoza A, Demark-Wahnefried W, Adams-Campbell L. The feasibility and acceptability of a diet and exercise trial in overweight and obese black breast cancer survivors: the stepping STONE study. Contemp Clin Trials. 2016;46:106–13.

    Article  PubMed  Google Scholar 

  57. Chee W., Lee Y., Im E. O., Chee E., Tsai H. M., Nishigaki M., Yeo S. A., Schapira M. M., Mao J. J., A culturally tailored Internet cancer support group for Asian American breast cancer survivors: a randomized controlled pilot intervention study. J Telemed Telecare, 2016.

  58. Smith SA, Whitehead MS, Sheats JQ, Fontenot B, Alema-Mensah E, Ansa B. Formative research to develop a lifestyle application (app) for African American breast cancer survivors. J Ga Public Health Assoc. 2016;6(1):50–9.

    PubMed  PubMed Central  Google Scholar 

  59. Koene RJ, Prizment AE, Blaes A, Konety SH. Shared risk factors in cardiovascular disease and cancer. Circulation. 2016;133(11):1104–14.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Blanchard CM, Courneya KS, Stein K. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008;26(13):2198–204.

    Article  PubMed  Google Scholar 

  61. Tomlinson D, Diorio C, Beyene J, Sung L. Effect of exercise on cancer-related fatigue: a meta-analysis. Am J Phys Med Rehabil. 2014;93(8):675–86.

    Article  PubMed  Google Scholar 

  62. LaVoy EC, Fagundes CP, Dantzer R. Exercise, inflammation, and fatigue in cancer survivors. Exerc Immunol Rev. 2016;22:82–93.

    PubMed  PubMed Central  Google Scholar 

  63. Izano MA, Fung TT, Chiuve SS, Hu FB, Holmes MD. Are diet quality scores after breast cancer diagnosis associated with improved breast cancer survival? Nutr Cancer. 2013;65(6):820–6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62(1):30–67.

    Article  PubMed  Google Scholar 

  65. Aycinena A. C., Jennings K. A., Gaffney A. O., Koch P. A., Contento I. R., Gonzalez M., Guidon E., Karmally W., Hershman D., Greenlee H., Cocinar Para Su Salud! Development of a culturally based nutrition education curriculum for Hispanic breast cancer survivors using a theory-driven procedural model. Health Educ Behav, 2016.

  66. Vigen C, Kwan ML, John EM, Gomez SL, Keegan TH, Lu Y, Shariff-Marco S, Monroe KR, Kurian AW, Cheng I, Caan BJ, Lee VS, Roh JM, Bernstein L, Sposto R, Wu AH. Validation of self-reported comorbidity status of breast cancer patients with medical records: the California breast cancer survivorship consortium (CBCSC). Cancer Causes Control. 2016;27(3):391–401.

    Article  PubMed  Google Scholar 

  67. Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health. 2014;29(6):632–50.

    Article  PubMed  Google Scholar 

  68. Green BL, Krupnick JL, Rowland JH, Epstein SA, Stockton P, Spertus I, Stern N. Trauma history as a predictor of psychologic symptoms in women with breast cancer. J Clin Oncol. 2000;18(5):1084–93.

    Article  CAS  PubMed  Google Scholar 

  69. Gibson LE, Cooper S, Reeves LE, Anglin DM, Ellman LM. The association between traumatic life events and psychological symptoms from a conservative, transdiagnostic perspective. Psychiatry Res. 2017;252:70–4.

    Article  PubMed  Google Scholar 

  70. • Burg MA, Adorno G, Lopez ED, Loerzel V, Stein K, Wallace C, Sharma DK. Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. Cancer. 2015;121(4):623–30. Large, nationwide study ( N = 9105; 14 states) qualitatively analysing unmet needs of BCS.

    Article  PubMed  Google Scholar 

  71. Brooks SE, Muller CY, Robinson W, Walker EM, Yeager K, Cook ED, Friedman S, Somkin CP, Brown CL, McCaskill-Stevens W. Increasing minority enrollment onto clinical trials: practical strategies and challenges emerge from the NRG Oncology accrual workshop. J Oncol Pract. 2015;11(6):486–90.

    Article  PubMed  Google Scholar 

  72. Livaudais-Toman J, Burke NJ, Napoles A, Kaplan CP. Health literate organizations: are clinical trial sites equipped to recruit minority and limited health literacy patients? J Health Dispar Res Pract. 2014;7(4):1–13.

    PubMed  PubMed Central  Google Scholar 

  73. Balcazar H, Rosenthal EL, Brownstein JN, Rush CH, Matos S, Hernandez L. Community health workers can be a public health force for change in the United States: three actions for a new paradigm. Am J Public Health. 2011;101(12):2199–203.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Navarro AM, Senn KL, McNicholas LJ, Kaplan RM, Roppe B, Campo MC. Por la Vida model intervention enhances use of cancer screening tests among Latinas. Am J Prev Med. 1998;15(1):32–41.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Annina Seiler.

Ethics declarations

Conflicts of Interest

Annina Seiler, Kyle W. Murdock, Luz M. Garcini, Diana A. Chirinos, Jeffrey Ramirez, Brielle Jackson, and Christopher P. Fagundes declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psycho-Oncology and Supportive Care

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seiler, A., Murdock, K.W., Garcini, L.M. et al. Racial/Ethnic Disparities in Breast Cancer Incidence, Risk Factors, Health Care Utilization, and Outcomes in the USA. Curr Breast Cancer Rep 9, 91–99 (2017). https://doi.org/10.1007/s12609-017-0247-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-017-0247-6

Keywords

Navigation