Five Black Women Die Needlessly Per Day from Breast Cancer in the United States

Nearly five black women die needlessly per day from breast cancer in the United States – a total of 1,722  deaths annually – according to a study released today at the Avon Foundation Breast Cancer Forum and simultaneously published in Cancer Epidemiology. The 2012 Racial Disparity in Breast Cancer Mortality Study found that 21 of the 25* largest U.S. citieshave a black: white disparity in breast cancer mortality, 13 of which are statistically significant.

The study, conducted by Sinai Urban Health Institute and funded by the Avon Foundation for Women, is the first national study to examine the racial disparity in breast cancer mortality at the city level in the United States. The researchers analyzed breast cancer deaths reported between 2005-2007 against seven societal (ecological) risk factors, including race, poverty level and racial residential segregation. The authors conclude that societal issues such as poverty and racial inequities cause most of the disparity and genetic factors comprise a very small portion of the disparity.

The black: white disparity reflects the difference between the Non-Hispanic White and Non-Hispanic Black breast cancer mortality rates in the cities analyzed. In some cities, such as Detroit, where the white and black breast cancer mortality rates are both high, practically no disparity exists. If the disparity ratio is more than 1, then the black rate is higher; if the ratio is less than 1, then the white rate is higher. The number of excess deaths is a function of two factors: the size of the disparity and the size of the population of the city. Thus, although New York City has a very small disparity (1.24), the number of excess deaths from this disparity is 70 because of the large population size.  Chicago is much smaller than New York City, but its disparity (1.62) is much larger, resulting in a similar number of excess deaths (76).

Study Key Findings

21 of the 25 largest U.S. cities have a black: white disparity in breast cancer mortality     13 cities have a statistically significant disparity (disparity greater than 1): (in order of population size) New York City, Los Angeles, Chicago, Houston, Philadelphia, San Diego, Dallas, Jacksonville, Columbus, Memphis, Seattle, Boston and Denver     More than one black woman a week dies needlessly in both Chicago and New York because of the racial disparity     Memphis has the highest disparity of the 25 largest cities     San Francisco has the smallest disparity of the 25 largest cities

“Our research shows societal factors – not genetics – are largely to blame for the racial disparity in breast cancer mortality nationwide,” said Steve Whitman, Ph.D., director of Sinai Urban Health Institute and the study’s lead author. “When a woman believes genetics causes her disease, it breeds a sense of hopelessness and fear. Our study proves that black women can play an active role in reducing their risk of dying from breast cancer by getting screened and following through with treatment. But it’s incumbent on society to improve access to quality mammography and to ensure that breast cancer treatment is available to all women, including the under- and un-insured.”

Recommendations to Prevent Breast Cancer Deaths Following a 2007 Sinai Urban Health Institute study that produced alarming data on the racial disparity in Chicago’s breast cancer mortality, the Avon Foundation funded the establishment of the Metropolitan Chicago Breast Cancer Task Force to address the disparity.  The Task Force issued recommendations to improve screening quality and reduce disparities in Chicago that can be applied to other cities.

Four key recommendations to prevent breast cancer deaths are:

Ensure all women understand the importance of breast health screening.Women must be educated using culturally relevant breast health information through various methods, such as hotlines, multi-lingual websites, and education in local communities and places of worship. In Chicago, the Avon Foundation has funded hospital kiosks that produce a personalized breast health information brochure based on information a woman enters. A phone attached to the kiosk enables the woman to immediately schedule her mammogram.

Ensure all women have access to early detection programs and screening .  Low-income, uninsured, and underinsured women can visit to find low-cost breast cancer screenings across the United States.Improve the quality of breast cancer screenings for all women .

Improve screening quality by having health care organizations work together to create consortiums to ensure all breast centers are measured for quality, as well as establish best practices for diagnosis and follow-up tests. Organizations should also replace old mammography equipment with high-quality digital machines.

Ensure all women who need treatment receive high-quality treatment in a timely manner and are completing the recommended therapy .The Avon Foundation has funded patient navigators at hospitals across the country that care for uninsured and under-insured women.  Navigation programs have helped encourage early detection, decrease stage at diagnosis, decrease delays in care and improve quality and coordination of care.