A report from researchers at the Centers for Disease Control and Prevention (CDC) finds that despite significant progress in breast cancer detection and treatment, black women experience higher death rates even though they have a lower incidence of breast cancer compared to white women. Researchers analyzed breast cancer incidence, stage at diagnosis, and mortality rates for 2005–2009 for women in the United States and for each state, then calculated black to white mortality ratios and mortality to incidence ratios by race. They found despite having lower incidence rates, black women had a 41% higher breast cancer death rate. More black women were diagnosed at regional or distant cancer stage compared with white women (45% versus 35%). For every 100 breast cancers diagnosed, black women had nine more deaths than white women (27 deaths per 100 breast cancers diagnosed among black women compared with 18 per 100 among white women).
They conclude that advances in screening and treatment have improved survival for U.S. women with breast cancer, but that black women experience inequity in breast cancer screening, follow-up, and treatment after diagnosis, leading to greater mortality.
Below are comments from Otis W. Brawley, M.D., chief medical officer, regarding the study.
“The new report on black-white disparities in breast cancer from the CDC is important. It is well established that there are significant differences between blacks and whites in mortality from breast cancer. In 2010, the age adjusted mortality rate was 30.5 per 100,000 for black women and 21.6 per 100,000 for whites. Another way of saying this: black women have a breast cancer death rate that is 40 percent higher than that of white women.
“There has been a lot of discussion about the biology of breast cancer being more aggressive in blacks compared to whites. There has been far less attention given to the fact that the quality of care that black women receive is more likely to be lower than that received by white women. This report notes that there are states where black and white women have equal breast cancer death rates (Delaware, Nebraska, and Rhode Island). This is evidence that biological differences among the races is likely not the reason for the disparities.
“So what are the factors behind the disparity? The report notes blacks are significantly less likely to get high quality care. While mammography rates are similar between blacks and whites (about 75% of women over age 50), the quality of mammography may differ. Blacks are nearly twice as likely to have to wait more than 60 days for assessment of an abnormal mammogram compared to whites (20% v. 12%, respectively). And fewer black women get definitive breast cancer care in 30 days after diagnosis compared to whites (69% v. 82%, respectively).
“This report adds significantly to what is already a significant body of data on this issue. much of it contributed by American Cancer Society researchers. Numerous studies have shown that blacks are less likely to get optimal breast cancer care, be it appropriate hormonal therapy, chemotherapy, surgery, radiation therapy, or post treatment follow-up. The data show, importantly, that blacks are more likely to receive less than optimal care but it also shows that a small but significant portion of American women of all races get less than optimal care. I participated in a study that showed that 7.5% of blacks and 2% of whites living in metropolitan Atlanta and diagnosed with localized potentially curable breast cancer through screening had received no cancer specific therapy within one year of diagnosis. The bottom line is we need to assure that all women have access to high quality screening and high quality treatment.”