While White women are more likely to be diagnosed with breast cancer, Black women are more likely to die from it, according to a new report which found large and growing disparities in breast cancer mortality rates in the U.S. and many of its largest cities over the last two decades.
The 2014 Racial Disparity in Breast Cancer Mortality Study, conducted by Sinai Urban Health Institute and the Avon Foundation for Women and published in the journal Cancer Epidemiology, is the largest study of its kind and the first to examine racial disparities in breast cancer mortality in 50 U.S. cities between 1990 and 2009.
Of of the 41 cities that provided data, 39 had a disparity and 35 saw a widening gap in mortality rates over the 20-year period, the report stated.
The U.S. cities with the largest disparity between Black and White breast cancer mortality rates were, by highest rank: Memphis, Tenn.; Los Angeles; Wichita, Kan.; Houston; Boston; Denver; Chicago; Phoenix; Dallas and Indianapolis. New York has the smallest disparity of the 50 largest cities analyzed, followed by Baltimore.
“The fact that the disparity grew in so many cities is startling and alarming…. It showed us the problem was bigger than we thought,” Dr. Marc Hulbert, executive director of the Avon Breast Cancer Crusade and an author of the study, told the AFRO.
African-American women tend to be disproportionately diagnosed with triple-negative and aggressive cancers, Hurlbert said, but “those aggressive cancers alone cannot explain the variability.”
The study found that overall, breast cancer death rates decreased over the past two decades. However, the White death rate decreased twice as much as that of Black women.
Researchers concluded that the estimated 1,710 Black women—or approximately five women per day—who die annually from breast cancer do so largely because of differential access to quality screening and breast cancer treatment.
“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,” said Steve Whitman, director of Sinai Urban Health Institute and the study's senior author, in a statement. “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.”
The new report expands on a 2012 study that examined the racial disparity in breast cancer mortality over the three-year period of 2005 to 2007 in the 24 largest U.S. cities. After receiving calls from other cities asking to be included in the analysis, Hurlbert said, researchers decided to conduct a more comprehensive examination.
“Having the data at the city level is good because we can work with state and local hospitals and health centers to address these disparities,” Hurlbert said. “This really sets benchmarks at the city level so that these jurisdictions can measure themselves to see how they are doing and have a goal to improve upon.”
For example, in the 2012 report, Memphis had the largest disparity among the 25 most populous U.S. cities, and the Avon Foundation funded work at Memphis’ Methodist Hospital to identify the key barriers that could be driving local disparities.
“It’s going to take philanthropic groups and government groups and everyone working together—not just 'safety net' hospitals and health centers—to address this problem,” Hurlbert said.