A new perspective piece authored by researchers from the American Cancer Society and The University of Texas Health Science Center at San Antonio shows the high burden of breast cancer mortality among Black women as compared to White women began in the United States in the 1980s. At that time, breast cancer screening (mammography) and treatments (adjuvant postsurgery hormonal therapy) were disseminated widely in the United States, but unequally among Black and White women. The higher rate of breast cancer mortality in Black women than in White women is a reversal from before 1980, when Black women had lower breast cancer mortality. The perspective was published by Ismail Jatoi, MD, PhD, and colleagues in The New England Journal of Medicine.
Ismail Jatoi, MD, PhD
“Black women continue to have a disproportionate high burden of breast cancer mortality largely because of lack of health insurance and other socioeconomic barriers that limit access to high-quality care,” said Ahmedin Jemal, DVM, PhD, Senior Vice President of Surveillance & Health Equity Science at the American Cancer Society and senior author of the study. “To break down disparities in cancer outcomes, it is crucial to increase access to care for underserved populations and develop mechanisms to reverse course, from requirements for increased diversity in clinical trials to health system financial incentives for equitable care.”
Study authors calculated breast cancer incidence and death rates according to hormone receptor status, due to the fact that hormone receptor–positive cancers are more likely be detected early and treated more successfully and hormone receptor–negative cancers are less likely to be detected early and treated successfully. They found that Black women have a 19% higher mortality rate for hormone receptor–positive breast cancer types compared to non-Hispanic White women, despite having a 22% lower incidence rate. This finding dispels the notion that Black women have higher breast cancer death rates than White women largely because they are diagnosed with aggressive types of breast cancer, added Dr. Jemal.
Further, the authors found that Black women have a 123% higher mortality rate for hormone receptor–negative breast cancer compared to non-Hispanic White women, despite having a 65% higher incidence rate.
“Cancer disparities in the Black community result from a myriad of causes rooted in institutional inequities,” said Dr. Jemal. “We must address structural racism as a public health issue to close the gaps, advance health equity, and ensure Black women get the screening and treatment they need and deserve.”
Disclosure: For full disclosures of the study authors, visit nejm.org.
