nevertheless Breast cancer Black women are less common than white women and have a much higher risk of dying from illness.
In the United States, age-adjusted breast cancer mortality from 2014 to 2018 was about 40% higher in black women than in non-Hispanic white women.
This mortality gap may reflect the fact that black women face substantial barriers to timely and quality medical care compared to white women. Recent opinion piece.
the article is Published online June 18 The New England Journal of Medicine.
When the team looked at breast cancer mortality statistics, they found a surprise. The racial mortality gap dates back to 1980.
Prior to 1980, black women had a low breast cancer mortality rate. low Jatoi et al. Point out more than white women.
That year was a turning point in breast cancer management, as it was in the 1980s. Mammography Screening and adjuvant endocrine therapy are now available.
This was also when the racial mortality gap began to emerge.
As the author suggests, it was the disparity in access to the two new interventions that caused the difference. They comment that it’s pretty obvious why this happened.
“Black women are more likely to have less health insurance or indemnity than white women, limiting access to mammography screening and negatively impacting therapeutic decision-making.” The researchers point out.
In addition, both mammography screening and endocrine therapy benefit primarily to patients with hormone receptor (HR) -positive breast cancer. This is equally common for black and white patients. However, black women have a 65% higher incidence of HR-negative cancers than white women, and HR-negative tumors are often detected as palpable cancer between mammography examinations.
Black women also have an 81% higher incidence of triple-negative breast cancer, so the benefits of mammography screening and adjuvant endocrine therapy are small, both of which are beneficial in the detection and treatment of HR-positive breast cancer.
Some suggest that excessive HR-negative breast cancer in black women may be explained by genetic factors. However, as Jatoi and her colleagues point out, the incidence of HR-negative breast cancer has actually declined in all races in the United States since 1992.
However, the decline in black women was slow, and the decline in incidence was smaller for white women living in less wealthy areas of the United States than for white women in wealthier areas.
These patterns, as the authors observe, suggest that social determinants of health affect not only access and quality of health care, but also the development of HR-negative breast cancer.
“If all people with breast cancer benefit equally from effective medical interventions, racial differences in mortality for individual tumor subtypes will primarily reflect differences in incidence,” Jatoi and colleagues said. Continues.
However, statistics show that the substantial racial disparity in both HR-positive and HR-negative cancer mortality between black and white women cannot be explained by the difference in the incidence of either tumor alone. They write.
For example, black women have a 19% higher mortality rate for HR-positive breast cancer than white women, while black women have a 22% lower incidence of HR-positive breast cancer.
Similarly, mortality from HR-negative breast cancer is more than twice as high in black women as in white women, a significant disparity compared to the 65% relative difference in the incidence of HR-negative breast cancer between the two races. there is.
“Universal insurance has the potential to reduce disparities in the treatment of all subtypes of cancer, including triple-negative breast cancer,” emphasizes Jatoi et al.
“Ensuring universal access to quality health care can significantly narrow the racial disparity in breast cancer mortality in the United States,” they conclude.
The author does not report any relevant financial relationships.
N Engl J Med. Published online on June 18, 2022. Full text
