A national study published today found a black: white disparity in breast cancer mortality in 39 of the most populous U.S. cities, with 35 of those cities experiencing a widening disparity over a 20-year period from 1990 to 2009. The 2014 Racial Disparity in Breast Cancer Mortality Study is the largest study of its kind and the first to examine racial disparities in breast cancer mortality in 50 cities over two decades. The study, released by the Avon Foundation for Women and published in Cancer Epidemiology, found that 1,710 black women – approximately five women per day – die on average annually largely due to racial disparities in screening and breast cancer treatment.
The U.S. cities with the largest disparities are (in order of disparity ratio): Memphis, Tenn.; Los Angeles, Calif.; Wichita, Kan.; Houston, Texas; Boston, Mass.; Denver, Colo.; Chicago, Ill.; Phoenix, Ariz.; Dallas, Texas; Indianapolis, Ind.
For national and city-specific data, please visit: http://www.avonfoundation.org/causes/breast-cancer-crusade/disparities-study/
2014 Racial Disparity in Breast Cancer Mortality Study Findings
The 2014 study, conducted by Sinai Urban Health Institute and the Avon Foundation for Women, expands on a 2012 study that examined the racial disparity in breast cancer mortality over a three-year period (2005-2007) in the 24 largest U.S. cities. In an effort to see how these disparities changed over a longer time period, this new study analyzed the number of breast cancer deaths reported across four five-year intervals between 1990 and 2009 in the 50 largest U.S. cities; data were available for 41 of the most populous 50 cities.
The study found that in most cities the white death rate declined between 1990 and 2009, while the black death rate did not change substantially, resulting in an increasing disparity. Although the death rates declined for both white and black women in the United States as a whole over this time period, the white death rate decreased twice as much, leading the researchers to identify four key factors that led to this racial disparity in breast cancer mortality: differential access to screening, quality of the screening process, access to treatment, and quality of treatment.
Steve Whitman, Ph.D., director of Sinai Urban Health Institute and the study’s senior author, explained the disparity: “The geographical variation and growth in the black: white disparity over time shows that genetic factors comprise only a very small portion of the breast cancer mortality disparity. Rather, we believe a more logical explanation for the disparity is that certain technological advances related to screening and treatment that became available in the 1990s – such as digital mammography, advances in surgery and new drugs for treatment – have been less accessible to black women, who are disproportionately poor and un- or under-insured and less able to obtain access to these advances.”
· Few of the cities had a black: white disparity during the first time period (1990-1994), yet by the most recent time period (2005-2009), 39 of the 41 cities analyzed had a black: white disparity in breast cancer mortality, 23 of which were statistically significant
· Between 1990 and 2009, 35 cities saw an increase in the disparity during the 20-year period
· 16 cities trended towards a black: white disparity in breast cancer survival, but did not reach statistical significance (likely due to sample size)
· Memphis has the highest disparity of the 41 largest cities analyzed, followed by Los Angeles
· New York has the smallest disparity of the 50 largest cities analyzed, followed by Baltimore
“The 2014 Racial Disparity in Breast Cancer Mortality Study has made it evident that a large racial disparity for breast cancer mortality exists in the United States. While the size of that disparity varies, it exists in virtually every one of the cities analyzed – and it appears to be growing,” said Marc Hurlbert, Ph.D., executive director of the Avon Breast Cancer Crusade. “Public and private institutions in these cities need to join together to address these disparities. The burden cannot be left only to the ‘safety net’ hospitals and health centers.”
After the 2012 disparities study that showed Memphis had the highest disparity of the largest 25 U.S. cities, the Avon Foundation funded work at Memphis’ Methodist Hospital to identify the key barriers that could be driving local disparities. The report from the study in Memphis will be released March 18 at the Avon Foundation Breast Cancer Forum in Washington, D.C. and will inform future Avon funding in that city.
Five Recommendations to Reduce The Risk of Breast Cancer
Dr. Marc Hurlbert provides five tips about how women can reduce their risk of developing breast cancer:
1. Seek access to early detection programs and screening
- Low-income, uninsured and underinsured women can visit www.cdc.gov/cancer/breast to find low-cost breast cancer screenings across the United States.
2. Be knowledgeable of family and personal history
- If close relatives such as a mother, aunt or grandmother – or even male relatives – have had breast cancer, speak with a primary care doctor or Ob/Gyn about your specific risks and screening options.
- Alert your doctor to personal risk factors such as childbearing history, your hormone replacement use, and radiation exposure to the chest if treated for lymphoma as a child
3. Reduce alcohol use
- Regular consumption of one or more drinks a day for women is associated with an increased risk of breast cancer.
4. Maintain a healthy weight
- Staying healthy lowers the odds of getting breast cancer. Obesity and being overweight are linked to a higher risk of breast cancer, especially after menopause. To help maintain a healthy weight, eat more vegetables and fruits and limit red meat consumption.
5. New moms should breastfeed immediately after birth
- Experts recommend nursing a newborn within an hour of giving birth, if possible, and not supplementing with formula while in the hospital. Doctors recommend new mothers should breastfeed for at least six months. After a woman gives birth, she has a slightly increased risk for developing breast cancer over the next five to ten years (known as pregnancy-associated breast cancer).
The researchers – led by Bijou Hunt, the study’s main methodologist – measured racial disparity by calculating non-Hispanic black: non-Hispanic white breast cancer mortality rate ratios in each of the cities analyzed. A disparity ratio of greater than one indicates a higher black mortality rate; a ratio of less than one indicates a higher white death rate. In accordance with the our previous 2012 study’s findings, results showed that some cities, such as Detroit and Las Vegas, have no disparity because mortality rates from breast cancer for both white and black women are unacceptably high. In contrast, New York, for example, has low mortality rates for both black and white women and continues to have the smallest disparity among the most populous cities. This study demonstrates the geographical variation in disparities and that the black: white breast cancer mortality disparity expanded in the majority of cities over the observed 20-year period (1990 - 2009).
About the Avon Breast Cancer Crusade
The Avon Breast Cancer Crusade, which launched in 1992 and is led by the U.S.-based Avon Foundation for Women, has placed Avon and the Avon Foundation for Women at the forefront of the fight against breast cancer; today, Avon is the leading corporate supporter of the cause globally. Avon breast cancer programs in more than 50 countries have donated more than $815 million for research and advancing access to care, regardless of a person’s ability to pay. Avon awards funding to beneficiaries ranging from leading cancer centers to community-based grassroots breast health programs to support breast cancer research and access to care. The Crusade has enabled more than 18 million women globally to receive free mammograms and breast cancer screenings, educated more than 145 million women about breast cancer, and funded promising research into the causes of breast cancer and ways to prevent the disease. The Avon Foundation raises funds for the Crusade through the sale of Avon “Pink Ribbon” products, and through events such as the U.S. Avon Walk for Breast Cancer series being held in 2014 in Houston (April 12-13); Washington (May 3-4); Boston (May 17-18); Chicago (May 31-June 1); San Francisco (July 12-13); Santa Barbara, Calif. (September 6-7); New York (October 18-19); and Charlotte, N.C.(October 25-26). Visit www.avonfoundation.org for more information.
About Sinai Health System
Sinai Health System, a Chicago-based private, not-for-profit organization, is comprised of seven member organizations: Mount Sinai Hospital, Holy Cross Hospital, Sinai Children’s Hospital, Schwab Rehabilitation Hospital, Sinai Medical Group, Sinai Community Institute and Sinai Urban Health Institute. The system has over 800 physicians on its hospital medical staffs, 695 licensed beds, 100,000+ annual emergency department patient visits and eight physician residency training programs. www.sinai.org