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Care and Outcome Differ for African-American Women

CDC report shows disparities in breast cancer detection, survival persist between African-Americans and whites

December 20, 2012

Written By Nicole Katze, MA, Writer and Editorial Coordinator
Reviewed By Dianne L. Hyman, MSN, RN, OCN

A report issued by the U.S. Centers for Disease Control and Prevention shows that African-American women are diagnosed with breast cancer less often than white women but continue to experience higher death rates.

The report concluded that differences in detection and treatment initiation, as well as stage at diagnosis, contribute to the imbalance between races.

Reason for the Study

Several studies have shown that some groups have benefitted more than others from advances in breast cancer screening and treatment.

The CDC Vital Signs program targets an important public health topic each month with the goal of encouraging states to improve in the areas selected. In November, CDC chose to report on differences in breast cancer screening, treatment and mortality rates between African-American women and white women. The mortality rate is the number of deaths per 100,000 women diagnosed with breast cancer.

Structure of the Study

Investigators collected data on women newly diagnosed with breast cancer between 2005 and 2009 from the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance Epidemiology and End Results databases. Participants were categorized by cancer stage, race and age group. Information on death from breast cancer was based on death certificate information as reported to state statistics offices.

Statistics were based on U.S.population estimates from the U.S. Census Bureau.

Results

An average of 205,246 women were diagnosed with invasive breast cancer each year between 2005 and 2009. Of that number, 21,942 were African-American and 173,970 were white. The researchers found:

  • African-American women were more likely to be diagnosed at a higher stage of disease than white women (37 percent versus 30 percent with cancer in nearby lymph nodes, 8 percent versus 5 percent with cancer in other organs)
  • African-American women had a 41 percent higher death rate than white women (31.6 deaths per 100,000 diagnoses, versus 22.4 deaths per 100,000 diagnoses)
  • African-American women tended to report longer periods between screening mammograms, and between an abnormal mammogram and diagnosis, than white women
  • African-American women were more likely to be diagnosed with cancer subtypes considered more aggressive, especially triple-negative breast cancer
  • After diagnosis, fewer African-American women started treatment within 30 days compared to white women (69 percent versus 82 percent)

The researchers recommend greater focus on one-on-one education, reminders to follow up after suspicious mammograms, reducing out-of-pocket costs for screening and treatment, and stronger navigation through the healthcare system.

Further research is needed to understand the relationship between triple-negative breast cancer and ethnicity.Those studies are ongoing.

Limitations

The authors noted three possible limitations, because of the broad nature of this study population and its reliance on accurate record-keeping.

First, study investigators did not verify cause of death, although an earlier CDC study verified 98 percent of breast cancer deaths using the National Death Index.

Second, race and ethnicity can be misclassified, although this is considered uncommon.

Lastly, population estimates came from the U.S. Census Bureau. These change over time and can lead to over- or under-estimates of death rates and occurrence.

What This Means For You

These data show African-Americans may not receive or have access to the same quality of care as their white peers. The reasons vary, but researchers suggest screening and treatment resources may be limited, or too costly, for some African-American women. Previous studies show that longer intervals between screening mammograms leads to diagnoses at later stages, with more invasive therapies needed. Starting treatment within weeks of diagnosis, and following up with your doctor after an abnormal mammogram, can help ensure you receive optimal care.

If you have trouble accessing screening or breast cancer education programs, talk with your primary care doctor, a nurse or a social worker about resources that may exist in your area.You can also call our Breast Cancer Helpline at (888) 753-LBBC (5222) for guidance and peer support. See LBBC’s resources for African-American women for more information.

Cronin, Kathleen A., Richardson, Lisa C. et al: Vital Signs: Disparities in Breast Cancer Severity – United States, 2005-2009. Centers for Disease Control and Prevention (November 16, 2012)

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