Eliminating health disparities is a worldwide goal. The initiatives cited in Healthy People 2020 have a strong emphasis on strategies to decrease health disparities in the United States.
It is important for health care providers to recognize that health disparities exist and offer strategies to remedy these risks.
Preventive screening can play a critical role in the early diagnosis and prompt treatment of cancer. One major health care disparity for African Americans is the use of preventive health services. African American women are less likely to use preventive care services than are Caucasian women, which contributes to racial health disparities.
For example, African Americans have some of the highest death rates related to cancer and some of the lowest rates of preventive screening (Cancer facts and figures for African Americans, 2013-2014, American Cancer Society). Breast cancer is the most common type of cancer among African American women (U.S. Cancer Statistics Working Group, 2013).
African American women are less likely to have regular breast cancer screenings, resulting in advanced stage diagnosis and poorer prognosis (Pullen, Perry, and Oser. Sociol Health Illn. 2014;36:1037-1053).
Although Caucasian women have a higher incidence rate for breast cancer, African American women are more likely to die from breast cancer. The five-year relative survival rate is 77% for African Americans, compared with 90% among Caucasian women (U.S. Cancer Statistics Working Group, 2013).
Cervical cancer also affects African American women disproportionally. More than 50% of cervical cancer occurs in women who never had a pap smear or were not tested within five years (U.S. Cancer Statistics Working Group, 2013). African American women are two times more likely to die from cervical cancer than are Caucasian women (U.S. Cancer Statistics Working Group, 2013).
Colorectal cancer is the third most common form of cancer in African American men and women. The death rates from colorectal cancer are higher among African Americans than in any other racial or ethnic group in the United States. Early screening can lead to polyp removal, which can help prevent the development of colorectal cancer. To decrease and ultimately eliminate this disparity for African American women, the use of preventive health services, such as screenings for breast, cervical, and colorectal cancer, must be paramount.
Conway-Phillips and Millon-Underwood (ABNF. 2009;20:97-101) identified barriers for African American women participating in breast cancer screenings as costs associated with mammograms, being underinsured or uninsured, mistrust in physicians, lack of understanding regarding benefits of screening, and fear that testing is harmful or may indicate a cancer diagnosis.
Addressing and overcoming barriers would increase the use of preventive health services and decrease mortality rates for the African American community.
Clinicians can make a difference by providing culturally competent health education, encouraging appropriate screening, and offering timely follow-up. Providers can play a vital role in reducing health disparities for African American women through encouraging strategic and timely implementation of preventive health services.
Shannon M. Morris, DNP, FNP-C, is a clinical supervisor at Texas Health.
Sharon M. Fruh, PhD, RN, FNP-BC, teaches at the University of South Alabama, College of Nursing.