R ACIAL D ISPARITIES & B REAST C ANCER Leah Calvert PHE 510: Public Health & Social Justice Spring 2009

I NTRO 10% drop in breast cancer rates in U.S. Racial disparity in health outcomes Higher death rates, but lower incidence Public health professionals have a responsibility to address and reduce health disparities

B REAST C ANCER F ACTS All women at risk – tends to increase with age Most commonly diagnosed cancer in African American women 2 nd to only lung cancer in female deaths Most common type (excluding non-melanoma skin cancer)

R ACIAL D ISCRIMINATION & B REAST C ANCER Association between racial discrimination & stress Study: racial discrimination & risk of developing breast cancer On the job discrimination – 32% higher risk of breast cancer

H EALTH D ISPARITIES : I NCIDENCE Incidence Rates by Race (2007 statistics from CDC) Race/EthnicityIncidence Per 100,000 women All Races127.8 White132.5 African American118.3

H EALTH O UTCOMES 5 year survival rate, 60% compared to 77% (1975) 5 year survival rate, 70% compared to 85% (1990) 5 year survival rate, 74% compared to 97% (2001)

H EALTH D ISPARITIES : M ORTALITY Mortality Rates by Race/Ethnicity (2007 Statistics from CDC) Race/EthnicityMortality Rate per 100,000 All Races25.5 White25.0 African American33.8

D ELIVERY OF H EALTH C ARE Percentage of U.S. women (age 40+) who received a mammogram in past year Screening raises odds 70% in among African American women Year of Mammogram (Data from CDC) Race White African American

D ELIVERY OF H EALTH C ARE Less likely to be caught in early stages Less adequate screening results/follow-up “Did not discuss test/examination findings” 34% had survival knowledge – compared to 57% of white counterparts

O PPORTUNITIES TO R EDUCE D ISPARITIES Educate African American women about breast cancer outcomes Work within health systems to improve physician/patient communication Continue to promote screening – but focus on improving follow-up care for African Americans

W ORKS C ITED American Cancer Society. “Race and Ethnicity affect Breast Cancer Outcome.” Feb ancer_Outcome.asp. Accessed 24 April ancer_Outcome.asp Brach, Cindy and Irene Fraserirector. “Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model.” Medical Care Research Review (2000): Accessed 23 April Centers for Disease Control and Prevention. “Mammography Percentages by Race and Ethnicity.” Breast Cancer Statistics. Accessed 22 April DeSantis C., et al. "Temporal trends in breast cancer mortality by state and race.” Cancer Causes Control (2008): Accessed 20 April f606e7b899de4f6&pi=10 8f606e7b899de4f6&pi=10 Gamble, Vanessa Northington, MD, PhD. “Under the Shadow of Tuskegee: African Americans and Health Care”. American Journal of Public Health (1997): Accessed 25 April Grouse, Lynette. “Reducing Disparities in Cancer Health Care.” National Cancer Institute. Nov Accessed 24 April Imaginis. “Breast Cancer: Statistics on Incidence, Survival, and Screening.” Imaginis: The Women’s Health Resource. Jan Accessed 23 April

W ORKS C ITED C ONT Lee, Christopher. “Studies Look for Reasons Behind Racial Disparities in Health Care.” The Washington Post. Oct dyn/content/article/2006/10/24/AR html. Accessed 23 April dyn/content/article/2006/10/24/AR html Medical News Today. “Breast Cancer Treatment Disparities Between Black, White Women in Georgia Exist Despite Health Insurance Status, Study Finds.” June Accessed 25 April Newman, Lisa A. MD et al. “Local Recurrence and Survival Among Black Women With Early- Stage Breast Cancer Treated With Breast-Conservation Therapy or Mastectomy.” Annals of Surgical Oncology. 6.3 (1999): Accessed 15 May Norton, Amy. “Breast Cancer Still Diagnosed Later in Black Women.” Dec Accessed 20 April Reuters Health. “Racial Discrimination Tied to Breast Cancer Risk.” American Journal of Epidemiology. July Accessed 25 April Science Daily. “American Cancer Society Report Finds Breast Cancer Death Rate Continues to Drop.” Accessed 18 April Stanford University, news release: “Ethnic Differences Can Play a Big Role in Medical Treatment,” October ( Accessed 22 April Surveillance Epidemiology and End Results. “Cancer Statistics: Fast Stats, Statistics Stratified by Race/Ethnicity.” n.d. National Cancer Institute. Taylor, Teletia R et. al. “Racial Discrimination and Breast Cancer Incidence in US Black Women.” American Journal of Epidemiology (2007): hhtp://aje.oxfordjournals.org/cgi/reprint/166/1/46. Accessed 22 April hhtp://aje.oxfordjournals.org/cgi/reprint/166/1/46