Mortality Disparity in Breast Cancer: Everyone Deserves Access to the Best Treatment

Patient Expert

A California study may provide another clue into the disparity in mortality between white and minority women with breast cancer.   An earlier study by the Sinai Urban Health Institute and the Avon Foundation for Women found that between 1990 and 2009 death rates from breast cancer declined at a faster rate for white women than for African-American women leading to a growing gap.

Lack of access to advances in breast cancer treatment

One factor that may contribute to the higher death rate for African-American women is the higher percentage of [inflammatory breast cancers]( ""It's the Kind Black Women Get" IBC and the African-American Community") and triple negative breast cancers in this population.   However, Steve Whitman, lead author for the Sinai Urban Health Study, points to the variation in survival rates in the cities surveyed as an indication that the type of breast cancer is not the primary reason for racial disparity in breast cancer mortality rates.   He thinks that black women have had less access to the advances in cancer detection and treatment that started in the 1990's such as digital mammography, better surgical techniques, and new drugs.

The California study published online March 2015 by JAMA Oncology surveyed 500 women with breast cancer and found that black and Hispanic women were more likely to follow their doctor's or insurance company's recommendations for surgeons and hospitals while white women were more like to say that they chose a surgeon or hospital based on reputation.   This led to some issues in disparity of care.   For example, the minority women were more likely to have their surgery at hospitals with lower rates of follow-up radiation after breast conservation surgery.

The importance of advocating for oneself

This small study in one state can't give us all the answers to a complicated question, but it might provide some insights.   One important factor in getting the best medical care is being able to advocate for oneself.   Apparently more of the white women in this study asked questions about the reputation of surgeons and hospitals and were able to find the highest quality surgeons and hospitals.

Much is left unanswered.   Were the minority women too intimidated by medical personnel to ask questions?   Were they receiving their initial appointments at crowded clinics where the doctors were too rushed?   Did their insurance plans exclude them from the best facilities?   Did the doctors and nurses need more training in cultural sensitivity to make patients feel comfortable in speaking up?

The data is clear that poor women of all races need better access to medical care.   Too often top-notch medical facilities are not available in their communities, and the expensive technology and drugs that are saving the lives of their sisters with better insurance have been denied to them.

A church-community partnership

Finding ways to empower minority women to take charge of their health is one factor in reducing mortality disparity.   Although it isn't specifically directed to breast cancer, I was encouraged to see information about a program in my area that is building better health in the African-American and Hispanic communities.   In a partnership with the county health department and churches, Village HeartBEAT is using parish nurses and a team approach to help people learn how to manage their health better through exercise and diet.   Not only will exercise and a healthier diet reduce breast cancer risk in the participants, learning that they can take charge of their health and having a relationship with a parish nurse should help them access the best medical care if they should develop breast cancer.

It is time to end the mortality gap in breast cancer by tackling it on every front better access to high-quality medical care and better education on health issues so that women can take charge for themselves.

For more information on this topic:

African-American Women:   More Genetically Susceptible to Breast Cancer

["It's the Kind Black Women Get":   IBC and the African-American Community]( ""It's the Kind Black Women Get"")

The Breast Cancer Mortality Rate is Higher Among African-Americans

Breast Cancer Facts and Figures 2013-14.   American Cancer Society