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

2. 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

3. 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)

4. 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

5. 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

6. 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)

7. 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

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 19941998200020032005 White60.667.471.470.167.4 African American 64.366.067.870.464.9

9. 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

10. 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

11. W ORKS C ITED American Cancer Society. “Race and Ethnicity affect Breast Cancer Outcome.” Feb 2 2003. http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Race_And_Ethnicity_Affect_Breast_C ancer_Outcome.asp. Accessed 24 April 2009. http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Race_And_Ethnicity_Affect_Breast_C 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. 57.4 (2000): 181-217. http://mcr.sagepub.com.proxy.lib.pdx.edu. Accessed 23 April 2009.http://mcr.sagepub.com.proxy.lib.pdx.edu Centers for Disease Control and Prevention. “Mammography Percentages by Race and Ethnicity.” Breast Cancer Statistics. http://www.cdc.gov/cancer/breast/statistics/screening.htm. Accessed 22 April 2009.http://www.cdc.gov/cancer/breast/statistics/screening.htm DeSantis C., et al. "Temporal trends in breast cancer mortality by state and race.” Cancer Causes Control. 19.5 (2008):537-45. Accessed 20 April 2009. http://www.springerlink.com.proxy.lib.pdx.edu/content/c14t08t54317lg18/?p=51303ae946304ef2 8f606e7b899de4f6&pi=10 http://www.springerlink.com.proxy.lib.pdx.edu/content/c14t08t54317lg18/?p=51303ae946304ef2 8f606e7b899de4f6&pi=10 Gamble, Vanessa Northington, MD, PhD. “Under the Shadow of Tuskegee: African Americans and Health Care”. American Journal of Public Health. 87.11 (1997): 1773-1778. http://www.ajph.org/cgi/reprint/87/11/1773.pdf Accessed 25 April 2009. http://www.ajph.org/cgi/reprint/87/11/1773.pdf Grouse, Lynette. “Reducing Disparities in Cancer Health Care.” National Cancer Institute. Nov 2005. http://www.cancer.gov/newscenter/benchmarks-vol5-Ussue6/page1. Accessed 24 April 2009.http://www.cancer.gov/newscenter/benchmarks-vol5-Ussue6/page1 Imaginis. “Breast Cancer: Statistics on Incidence, Survival, and Screening.” Imaginis: The Women’s Health Resource. Jan 2008. http://www.imaginis.com/breasthealth/statistics2.asp. Accessed 23 April 2009.http://www.imaginis.com/breasthealth/statistics2.asp

12. W ORKS C ITED C ONT Lee, Christopher. “Studies Look for Reasons Behind Racial Disparities in Health Care.” The Washington Post. Oct 2006. http://www.washingtonpost.com/wp- dyn/content/article/2006/10/24/AR2006102401184.html. Accessed 23 April 2009.http://www.washingtonpost.com/wp- dyn/content/article/2006/10/24/AR2006102401184.html Medical News Today. “Breast Cancer Treatment Disparities Between Black, White Women in Georgia Exist Despite Health Insurance Status, Study Finds.” June 2008. http://www.medicalnewstoday.com/articles/109683.php. Accessed 25 April 2009. http://www.medicalnewstoday.com/articles/109683.php 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):241-248. Accessed 15 May 2009. Norton, Amy. “Breast Cancer Still Diagnosed Later in Black Women.” Dec 2006. http://www.breastcancer.org/symptoms/new_research/20061204b.jsp) Accessed 20 April 2009. http://www.breastcancer.org/symptoms/new_research/20061204b.jsp Reuters Health. “Racial Discrimination Tied to Breast Cancer Risk.” American Journal of Epidemiology. July 2007. http://www.reuters.com/article/healthNews/idUSCOL55188620070705. Accessed 25 April 2009.http://www.reuters.com/article/healthNews/idUSCOL55188620070705 Science Daily. “American Cancer Society Report Finds Breast Cancer Death Rate Continues to Drop.” 2007. Accessed 18 April 2009. http://www.sciencedaily.com/releases/2007/09/070925130014.htmhttp://www.sciencedaily.com/releases/2007/09/070925130014.htm Stanford University, news release: “Ethnic Differences Can Play a Big Role in Medical Treatment,” October 1991. (http://news.stanford.edu/pr/91/911004Arc1132.html) Accessed 22 April 2009.http://news.stanford.edu/pr/91/911004Arc1132.html 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. 166.1 (2007):46-54. hhtp://aje.oxfordjournals.org/cgi/reprint/166/1/46. Accessed 22 April 2009. hhtp://aje.oxfordjournals.org/cgi/reprint/166/1/46