Minority Health and Health Equity Archive

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    Impact of Treatment and Socioeconomic Status on Racial Disparities in Survival Among Older Women With Breast Cancer
    (2008) Du, Xianglin L.; Fang, Shenying; Meyer, Tamra E.
    Abstract available from publisher's website.
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    A Qualitative Evaluation of a Faith-Based Breast and Cervical Cancer Screening Intervention for African American Women
    (2006) Matthews, A. K.; Berrios, N.; Darnell, J. S.; Calhoun, E.
    Abstract available at publisher's web site.
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    NCI Awards $19.3M for Multisite Investigation of Cancer Disparities
    (2011) UNSPECIFIED
    Why are African-American women more likely than those of European descent to be diagnosed with breast cancer at a young age, and with poor prognoses? It’s a provocative question, and one that a multidisciplinary team from the Slone Epidemiology Center at Boston University (BU), the University of North Carolina Lineberger Comprehensive Cancer Center (UNC) and Roswell Park Cancer Institute (RPCI) are coming together to address, supported by a five-year, $19.3 million award from the National Cancer Institute (NCI). This “team science” effort to better understand a significant health disparity will be led by Co-Principal Investigators Julie Palmer, ScD, from BU, …
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    Consensus recommendations for advancing breast cancer: risk identification and screening in ethnically diverse younger women.
    (2011) Stojadinovic, Alexander; Summers, Thomas A; Eberhardt, John; Cerussi, Albert; Grundfest, Warren; Peterson, Charles M; Brazaitis, Michael; Krupinski, Elizabeth; Freeman, Harold
    A need exists for a breast cancer risk identification paradigm that utilizes relevant demographic, clinical, and other readily obtainable patient-specific data in order to provide individualized cancer risk assessment, direct screening efforts, and detect breast cancer at an early disease stage in historically underserved populations, such as younger women (under age 40) and minority populations, who represent a disproportionate number of military beneficiaries. Recognizing this unique need for military beneficiaries, a consensus panel was convened by the USA TATRC to review available evidence for individualized breast cancer risk assessment and screening in young (< 40), ethnically diverse women with an overall goal of improving care for military beneficiaries. In the process of review and discussion, it was determined to publish our findings as the panel believes that our recommendations have the potential to reduce health disparities in risk assessment, health promotion, disease prevention, and early cancer detection within and in other underserved populations outside of the military. This paper aims to provide clinicians with an overview of the clinical factors, evidence and recommendations that are being used to advance risk assessment and screening for breast cancer in the military.
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    Interventions to Increase Mammography Rates Among U.S. Latinas: A Systematic Review
    (2010) Corcoran, Jacqueline; Dattalo, Patrick; Crowley, Meghan
    Background: In the United States, health disparities exist in mammography rates for Latinas compared with other ethnic groups. Additionally, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths among Latina women. Increased mammography rates and earlier breast cancer diagnosis can decrease breast cancer fatality rates among Latina women. Methods: The purpose of this systematic review was to contribute to the knowledge basis on breast cancer prevention for U.S. Latinas by determining the effectiveness of interventions designed to increase mammography rates among this population. Both experimental and quasi-experimental studies were included in the systematic review, and nine were located that met inclusion criteria. Results: Odds ratios were calculated, and the overall effect indicated a low level of effectiveness. Conclusions: Implications of findings for practice and research are discussed
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    Having health insurance does not eliminate race/ethnicity-associated delays in breast cancer diagnosis in the District of Columbia
    (2011) Hoffman, Heather J.; LaVerda, Nancy L.; Levine, Paul H.; Young, Heather A.; Alexander, Lisa M.; Patierno, Steven R.
    BACKGROUND: Delays in follow-up after breast cancer screening contribute to disparities in breast cancer outcomes. The objective of this research was to determine the impact of race/ethnicity and health insurance on diagnostic time, defined as number of days from suspicious finding to diagnostic resolution. METHODS: This retrospective cohort study of 1538 women examined for breast abnormalities between 1998-2010 at 6 hospitals/clinics in the District of Columbia measured mean diagnostic times between non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics with private, government, or no health insurance by using a full-factorial ANOVA model. RESULTS: Respective average—geometric mean (95% CI)—diagnostic times (in days) for NHWs, NHBs, and Hispanics were 16 (12, 21), 27 (23, 33), and 51 (35, 76) among privately insured; 12 (7, 19), 39 (32, 48), and 71 (48, 105) among government insured; 45 (17, 120), 60 (39, 92), and 67 (56, 79) among uninsured. Government insured NHWs had significantly shorter diagnostic times than government insured NHBs (P = .0003) and Hispanics (P < .0001). Privately insured NHWs had significantly shorter diagnostic times than privately insured NHBs (P = .03) and Hispanics (P < .0001). Privately insured NHBs had significantly shorter diagnostic times than uninsured NHBs (P = .03). CONCLUSIONS: Insured minorities waited >2 times longer to reach their diagnostic resolution than insured NHWs. Having private health insurance increased the speed of diagnostic resolution in NHBs; however, their diagnostic time remained significantly longer than for privately insured NHWs. These results suggest diagnostic delays in minorities are more likely caused by other barriers associated with race/ethnicity than by insurance status. Cancer 2011;. © 2011 American Cancer Society.
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    Disentangling the effects of race on breast cancer treatment
    (2007) Banerjee, Mousumi; George, Julie; Yee, Cecilia; Hryniuk, William; Schwartz, Kendra
    BACKGROUND. African Americans (AA) have higher mortality from breast cancer compared with white Americans (WA). Studies using population-based cancer registries have attributed this to disparities in treatment after normalizing the AA and WA populations for differences in disease stage. However, those studies were hampered by lack of comorbidity data and limited information about systemic treatments. The objective of the current study was to investigate racial disparities in breast cancer treatment by conducting a comprehensive medical records review of women who were diagnosed with breast cancer at the Karmanos Cancer Institute (KCI) in Detroit, Michigan. METHODS. The study cohort consisted of 651 women who were diagnosed with primary breast cancer between 1990 and 1996 at KCI. Multivariable logistic regression analysis controlling for sociodemographic factors, tumor characteristics, comorbidities, and health insurance status was used to assess whether there were differences between WA and AA in the receipt of breast-conserving surgery (BCS), radiation, tamoxifen, and chemotherapy. RESULTS. There was no significant difference between WA and AA in the receipt of BCS versus mastectomy. Patients with local-stage disease who were enrolled in government insurance plans underwent mastectomy more often (vs BCS plus radiation) compared with patients who were enrolled in nongovernment plans. The rates of receipt of tamoxifen and chemotherapy were similar for local-stage WA and local-stage AA. However, WA were more likely to receive tamoxifen and/or chemotherapy for regional-stage disease. Married women with regional disease were more likely to receive chemotherapy than nonmarried women. CONCLUSIONS. The results from this study may be used to target educational interventions to improve the use of adjuvant therapies among AA women who have regional-stage disease. Cancer 2007 © 2007 American Cancer Society.
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    Racial variation in breast cancer treatment among department of defense beneficiaries
    (2011) Enewold, Lindsey; Zhou, Jing; McGlynn, Katherine A.; Anderson, William F.; Shriver, Craig D.; Potter, John F.; Zahm, Shelia H.; Zhu, Kangmin
    BACKGROUND: Although the overall age-adjusted incidence rates for female breast cancer are higher among whites than blacks, mortality rates are higher among blacks. Many attribute this discrepancy to disparities in health care access and to blacks presenting with later stage disease. Within the Department of Defense (DoD) Military Health System, all beneficiaries have equal access to health care. The aim of this study was to determine whether female breast cancer treatment varied between white and black patients in the DoD system. METHODS: The study data were drawn from the DoD cancer registry and medical claims databases. Study subjects included 2308 white and 391 black women diagnosed with breast cancer between 1998 and 2000. Multivariate logistic regression analyses that controlled for demographic factors, tumor characteristics, and comorbidities were used to assess racial differences in the receipt of surgery, chemotherapy, and hormonal therapy. RESULTS: There was no significant difference in surgery type, particularly when mastectomy was compared with breast-conserving surgery plus radiation (blacks vs whites: odds ratio [OR], 1.1; 95% confidence interval [CI], 0.8-1.5). Among those with local stage tumors, blacks were as likely as whites to receive chemotherapy (OR, 1.2; 95% CI, 0.9-1.7) and hormonal therapy (OR, 1.0; 95% CI, 0.6-1.4). Among those with regional stage tumors, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.4; 95% CI, 0.2-0.7) and hormonal therapy (OR, 0.5; 95% CI, 0.3-0.8). CONCLUSIONS: Even within an equal access health care system, stage-related racial variations in breast cancer treatment are evident. Studies that identify driving factors behind these within-stage racial disparities are warranted. Cancer 2011;. © 2011 American Cancer Society.
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    Race and Ethnicity and Breast Cancer Outcomes in an Underinsured Population
    (2010) Komenaka, I. K.; Martinez, M. E.; Pennington, R. E.; Hsu, C.-H.; Clare, S. E.; Thompson, P. A.; Murphy, C.; Zork, N. M.; Goulet, R. J.
    BACKGROUND: The disparity in breast cancer mortality between African American women and non-Hispanic white women has been the subject of increased scrutiny. Few studies have addressed these differences in the setting of equal access to health care. We compared the breast cancer outcomes of underinsured African American and non-Hispanic white patients who were treated at a single institution. METHODS: We conducted a retrospective review of medical records for breast cancer patients who were treated at Wishard Memorial Hospital from January 1, 1997, to February 28, 2006. A total of 574 patients (259 non-Hispanic whites and 315 African Americans) were evaluated. A Cox proportional hazards regression analysis for competing risks was performed. All statistical tests were two-sided. RESULTS: Sociodemographic characteristics were similar in the two groups, and both racial groups were equally unlikely to have undergone screening mammography during the 2 years before diagnosis. Most (84%) of the patients were underinsured. The median time from diagnosis to operation, receipt of adequate surgery, and use of all types of adjuvant therapy were similar in the two groups. Median follow-up was 80.3 months for non-Hispanic whites and 77.9 months for African Americans. After accounting for the effect of comorbidities, African American race was statistically significantly associated with breast cancer-specific mortality (African Americans vs non-Hispanic whites: 26.0% vs 17.5%, P = .028; hazard ratio [HR] of death = 1.64, 95% confidence interval [CI] = 1.06 to 2.55). Adjustment for age at diagnosis, clinical stage, and hormone receptor status attenuated the effect, and the effect of race on breast cancer-specific survival was no longer statistically significant (HR of death from breast cancer = 1.43, 95% CI = 0.89 to 2.30). After adjustment for sociodemographic factors, the hazard ratio for race was further attenuated (HR = 1.26; 95% CI = 0.79 to 2.00). CONCLUSIONS: In this underinsured population, African American patients had poorer breast cancer-specific survival than non-Hispanic white patients. After adjustment for clinical and sociodemographic factors, the effect of race on survival was no longer statistically significant.
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    Breast cancer knowledge, attitudes, and screening behaviors among African American women: the Black cosmetologists promoting health program
    (2007) Sadler, Georgia R; Ko, Celine M; Cohn, Jennifer A; White, Monique; Weldon, Rai-nesha; Wu, Phillis
    Background African American women have higher rates of breast cancer mortality than their white counterparts. Studies have suggested that this is partly caused by discovery of cancer at a later stage, highlighting the importance of encouraging early detection of breast cancer in this population. To guide the creation of a breast cancer education intervention and help focus other health educators' and clinicians' health promotion efforts, this study explored whether a cohort of African American women living in San Diego would demonstrate the possession of adequate baseline knowledge about breast cancer screening and adherence to widely recommended screening guidelines.Methods African American women (N = 1,055) from San Diego, California participated in a beauty salon-based survey about breast cancer knowledge, attitudes, and screening practices. Women's ages ranged from 20 to 94 years, with average age of 42.20 (SD = 13.53) years. Thirty-four percent reported completing college and/or some graduate school training, and 52% reported having some college or post high school formal training. Seventy-five percent of the sample reported working outside their home. Participating cosmetologists and their salons were recruited to the study through word-of-mouth referral by highly respected African American community leaders.Results Salon clients reported low rates of adherence to recommended breast cancer screening guidelines. Of the 1,055 participants, 31% reporting performing breast self-exam every month. Of those participants 40 and older, 57% reported having had a clinical breast exam and 43% reported having had a mammogram in the past year. Knowledge of breast cancer was associated with adherence to screening guidelines. While women recognized the serious health threat that breast cancer poses and that early detection of breast cancer is important, only 30% of women reported feeling well informed about the disease. Many participants demonstrated a lack of basic knowledge about breast cancer. The Health Belief Model postulates that access to such information is an essential element in the progression toward engaging in screening behaviors.Conclusion Data from this study reflect a continuing need for increased breast cancer education for African American women. In light of the considerable mainstream information available related to breast cancer, these data reinforce the need for more breast cancer education programs that are clearly intended to attract the attention of African American women.