African-American women in Memphis are more than twice as likely to die from breast cancer as their white counterparts, according to a study released last week.
A study conducted by the Sinai Urban Health Institute in Chicago, funded by the Avon Foundation Breast Cancer Crusade in New York and published in Cancer Epidemiology: The International Journal of Cancer Epidemiology, Detection and Prevention, is believed to be the first study to analyze the racial disparity in breast cancer deaths at the city level.
Although white women are more often diagnosed with breast cancer, black women are much more likely to die from the disease. The study estimated more than 1,700 black women annually die unnecessarily from breast cancer.
Race-specific mortality rates were presented for the nation’s 24 largest cities, finding disparities between black and white mortality rates in 21 of those cities.
“To look at this from a city standpoint is really good,” said Dr. Shelley White-Means, director of the Consortium for Health Education, Economic Empowerment and Research (CHEER), a health-equity research center housed at the University of Tennessee Health Science Center in Memphis and funded by the National Center for Minority Health and Health Disparities.
“Many states have been focusing on the geographic component, but have been looking more at state versus state or region versus region,” she said. “For instance, we’ve found that Southwest Tennessee has higher racial disparity in breast cancer instance rates than other regions of the state. But to look at the larger cities and make comparisons there I think is a really important contribution.”
The study showed San Francisco has the lowest rates of disparity in breast cancer mortality, but Memphis showed the most significant difference between mortality rates for white and black women.
White-Means said the results come as no surprise considering Memphis scores lowest on a range of health issues.
While some breast cancers in black women may be of a more aggressive variety with poorer survival rates, lower rate ratios in cities such as Baltimore and New York suggest that even if there are biological differences in tumor aggressiveness, they would not account for differences between cities.
The study suggests that access to care and structural issues, such as poverty and racism, are the root of the disparities in breast cancer mortality. White-Means said access to care poses a problem for many black women in Memphis, with a lack of insurance coverage being the obvious barrier.
“I’m not aware of anyone who gives free treatment for breast cancer,” she said. “I’m really optimistic about national health care reform. I think that provides options that haven’t previously been available. It would be possible for persons to get early treatment as opposed to later treatment because that also makes the difference.”
Black women tend to be diagnosed in later stages of breast cancer compared to white women. White-Means said a study conducted by CHEER showed black women receiving breast cancer treatment had significantly longer hospital stays than their white counterparts.
“We have disparities in education, which correlates with knowing about prevention, different disease stages and treatment options,” she said. “Educational disparities also transfer over to disparities in outcomes.”
CHEER’s research showed black women were also much less likely to undergo a mastectomy.
“It could be cultural, it could be the cost, or it could also be associated with mastectomies requiring more time off from work in order to recover,” White-Means said. “So differences in the workforce experience affect medical treatment options.”
She said there are also differences in patient-provider communication strategies and treatment modalities for persons of different races. Black women in Memphis, she said, also face physical barriers to care access, such as the location of providers and pharmacies, and transportation to and from medical facilities.
“Beyond poverty, another thing that this study brings out is segregation,” White-Means said. “Segregation is associated with differences not just in medical-related facilities but in other types of facilities – educational institutions, access to grocery stores that provide high-quality fruits and vegetables, and pharmacies for access to medications and health-enhancing resources. It’s especially challenging in cities like Memphis that are so dependent on buses as a source of public transportation.”
The Sinai Urban Health Institute Study concluded with researchers suggesting that the city may be “an ideal local level” for breast cancer analysis, since a smaller area “will have too few events for stable calculations.”
The authors also recommended that cities “compute these rates and rate ratios and open a discussion about disparities in breast cancer mortality in their communities. There is much to be gained and little to lose by doing this.”