1. #BlackHealthMatters: Improving Breast Cancer Outcomes for Black Women
Healthy Churches 2020
Hilton Head, North Carolina
November 15, 2017
Karen Winkfield, MD, PhD
Associate Professor, Radiation Oncology
Director, Office of Cancer Health Equity
Associate Director for Cancer Health Equity

2. 2017 Cancer Incidence/Mortality
Lung cancer is by far the most common fatal cancer in men (28%), followed by prostate (11%), and colon & rectum (9%). In women, lung (26%), breast (15%), and colon & rectum (9%) are the leading sites of cancer death.

3. Breast Cancer Disparities
Incidence Mortality

4. Breast Cancer Disparities
Black women are 41% more likely to die of breast cancer
Triple negative breast cancer is more common among black women
Hispanics and Blacks tend to be diagnosed with more advanced cancer and at a younger age
Women with low income and/or education levels are more likely to die from breast cancer 

5. Greatest Predictor of Health
Socioeconomic status
Income
Occupation
Education

7. Adjusted* Percentage of Patients Diagnosed 1995 through 1999 Receiving Guideline Therapy by Insurance Status and Race/Ethnicity
*Charlson score, stage, number of positive lymph nodes, residency training program, hospital bed size, age, marital status, % high school diploma, gender, geographic region
Source: Harlan, 2005

8. Disparities in Oncotype Dx Use
Davis et al. J Natl Compr Canc Netw Mar;15(3):

9. Use of Adjuvant Chemo/Hormonal Therapy for Early Stage, Node Negative Breast Cancer by Race/Ethnicity, and ER status 2000
Source: Harlan
unpublished
ER negative
ER positive

10. Discontinuation within 12 mos was associated with higher risk of death
Cancer Epidemiol Biomarkers Prev; 26(8) August 2017
14,000 Women age 65 years diagnosed with stage I–III breast cancer in Medicare Part-D from 2007 to 2009
Blacks were less likely to initiate hormone therapy [OR, 0.76; 95%, CI 0.66–0.88]
Discontinuation within 12 mos was associated with higher risk of death
UTX HEALTH, Houston

11. Percentage of Women Receiving Radiation Following Breast Conserving Surgery by Racial/Ethnicity and Year of Diagnosis
Tumor < 5cm
Source: SEER

12. What can be done to improve access to care?

16. Dr. Karen’s Triple “A” AAA Awareness Ambassadors Advocacy
Self-awareness; knowledge of disease
Ambassadors
Family, Friends, Neighbors
Advocacy
Personal/Family
Public-policy
Resource allocation decisions:
Political, economic, and social systems
Institutions
AAA

17. List of Resources CancerCare www.cancercare.org
American Cancer Society
Lazarex Cancer Foundation
Latinas Contra Cancer
Cancer Services
Health & Human Services – Comprehensive Cancer Programs
WFBCCC Office of Cancer Health Equity
(336)

18. Thank you Questions? Dr. Karen Winkfield - kwinkfie@wakehealth.edu