Houston and Dallas are among the ten cities with the greatest black/white disparity in cancer mortality. This disparity was the focus of the 2014 Racial Disparity in Breast Cancer Mortality Study conducted by the Avon Foundation for Women and was published this month in Cancer Epidemiology. The study examined breast cancer mortalities from the 50 most-populous cities over the last two decades and found that approximately five black women die daily due to racial disparities in screening and breast cancer treatment.
The study was led by Bijou Hunt, who calculated non-Hispanic black : non-Hispanic white breast cancer mortality rate ratios for 41 of the 50 most-populous cities. A ratio greater than one indicated a greater black mortality rate, a ratio less than one indicated a greater white mortality rate, and a ratio of one indicated no disparity. Although most cities had a disparity, some cities, such as Detroit and Las Vegas, showed no disparity because mortality rates were all-around unacceptably high; in other cities, such as New York, mortality rates were low for both groups of women. Memphis had the highest disparity and New York had the lowest disparity.
Time, in addition to location, also had an impact on the disparity. During the 1990-1994 time period, few cities had a disparity, but during 2005-2009, the number jumped to 39 out of 41, and 23 were statistically significant. Overall, 35 cities saw an increase in the disparity between 1990 and 2009.
Death rates did decline for both white and black women over the 20 year period, but the white death rate decrease was twice as great as the black death rate decrease. This led the research team to identify four factors that led to the disparity: differential access to screening, quality of screening, access to treatment, and quality of treatment. Lead author Steve Whitman, Ph.D., director of Sinai Urban Health Institute, had an explanation: “The geographical variation and growth in the black: white disparity over time shows that genetic factors comprise only a very small portion of the breast cancer mortality disparity. Rather, we believe a more logical explanation for the disparity is that certain technological advances related to screening and treatment that became available in the 1990s … have been less accessible to black women, who are disproportionately poor and un- or under-insured and less able to obtain access to these advances.”
To combat the overall number of breast cancer mortalities, Marc Hurlbert, Ph.D., executive director of the Avon Breast Cancer Crusade has a few recommendations. First, low-income un/underinsured women can find low-cost breast cancer screenings through the Centers for Disease Control and Prevention (www.cdc.gov/cancer/breast). Second, women should know their family history of breast cancer. Third, women should limit their alcohol consumption to at most one drink a day. Fourth, women should maintain a healthy weight. Finally, new moms should breastfeed within an hour of giving birth to reduce the risk for pregnancy-associated breast cancer.