The disparity in breast cancer mortality between black women and white women has widened in 35 of the 50 most populous US cities over the past two decades, according to a new study. The work was conducted by researchers at Sinai Urban Health Institute in Chicago and the Avon Foundation for Women.
What should be good news — that mortality rates have decreased since 1990 in both groups of women — is tempered by data showing black women are much more likely to die of the disease than are white women — 70 percent more likely in some areas.
But building trust in the community and making cutting-edge screening technologies portable can help expand health care access, say researchers and coordinators at Fred Hutchison Cancer Research Center and Seattle Cancer Care Alliance.
The results “emphasize how prevalent” health disparities are between non-Hispanic whites and non-Hispanic African Americans, said Fred Hutch's Dr. Beti Thompson. “Even in cities where you’d expect outcomes to be more equal, you still see a gap,” she added, pointing to Minneapolis, where, despite a more liberal approach to health care access, African American women have a slightly higher breast cancer mortality rate than white women. “It’s just shocking, she said.”
Overall, black women in the study were 40 percent more likely to die of their breast cancer than were white women, and the researchers, led by Sinai Urban Health Institute’s director, Dr. Steve Whitman, noted that this translates into 1,710 deaths per year, or 5 women per day. “It’s absolutely startling and very dismal, because there is hardly any health measure in the United States that hasn’t improved in the last 20 years,” Whitman told The New York Times.
The disparity is due to a confluence of possible factors, noted Thompson, some genetic, some socioeconomic. Black women are more likely to be diagnosed with a type of breast cancer that resists current drugs like tamoxifen. Additionally, they have lower breast cancer screening rates and have higher rates of obesity, which increases cancer risk. Lower levels of education and income can also limit access to health care. These factors “all kind of build together” to affect mortality, said Thompson, who researches health disparities between Hispanic and non-Hispanic whites in Washington state’s Yakima Valley.
And black women are not alone among minority groups, she added. Similar trends of worse health outcomes compared to non-Hispanic whites have been seen in Asian Americans and Pacific Islanders, Thompson observed. And though Hispanic women have lower rates of breast cancer, their mortality rate equals that of white women.
‘You have to go where the women are’
One of the factors that may prevent minorities or people in underserved communities from seeking treatment “is being burned in the past,” said Julie Anne Black, who coordinates SCCA's mobile mammography van. A person with few economic reserves who visited the emergency room only to be saddled with a $3,000 bill might feel distrust of the health care system, but partnering with community health centers can help alleviate distrust, she explained.
This way, patients hear about screening from a trusted source and are able take advantage of the service in a location they know – such as the mobile mammography service that aims to take “state-of-the-art care out to areas that wouldn’t normally have access to it.”
Connecting with the community is critical to overcoming these obstacles and improving health outcomes in minority women, agreed Dr. Lora-Ellen McKinney, who sits on Fred Hutch’s Institutional Review Board and reviews applications for clinical trials. “You have to go where the women are,” noted McKinney. Examples in the black community could be beauty parlors or churches, which often have health ministries for their parishioners. Interpersonal relationships are critical, explained McKinney. People “need a direct referral from someone they trust.”
And it’s especially important that once a connection is made, “you keep going back,” said Dr. Hannah Linden, a Fred Hutch researcher and SCCA breast cancer oncologist who spearheads projects aimed at connecting with underserved communities to understand and dismantle barriers they face. She and her collaborators have worked to bridge the health care gap at SCCA and Harborview Medical Center by introducing health care navigators, who can help fill out forms, organize care, remind patients of appointments and even help patients who find themselves in financial distress. “You really need someone from the community, who knows where that bus stop is, who knows what it’s like to ride that bus,” she explained.
The Affordable Care Act, which provides for low- or no-cost cancer screenings, could help lower some barriers, Thompson said. “We hope it makes a difference. We’ll have to look at what happens.”
Due to medical advances, breast cancer has become more treatable and curable in the last 20 years, explained Fred Hutch’s Dr. Kerryn Reding, whose research focuses on reducing racial disparities in breast cancer. But this new study's findings suggest that black women have not benefitted from these advances. Enough research has been conducted to make it “clear the racial disparity gap is expanding,” said Reding. “Now is the time to address it.”
You can reach Sabrina Richards at srichar2@fredhutch.org.
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