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Journal of Clinical Oncology, Vol 24, No 14 (May 10), 2006: pp. 2170-2178 © 2006 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.05.4734
Racial and Ethnic Disparities in Breast Cancer Mortality: Are We Doing Enough to Address the Root Causes?
From the Section of General Internal Medicine and the Center for Interdisciplinary Health Disparities Research, The University of Chicago, Chicago, IL. Address reprint requests to Dionne Blackman, MD, Section of General Internal Medicine, The University of Chicago, 5841 S Maryland Avenue, MC3051, Chicago, IL 60637; e-mail: dblackma{at}medicine.bsd.uchicago.edu Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health systemlevel factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities. Supported by the National Institutes of Health (Bethesda, MD), National Institute of Environmental Health Sciences (Triangle Park, NC), and National Cancer Institute through the Centers for Population Health Disparities Program through Grant No. P50-ES12382-01. Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article. This article has been cited by other articles:
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Copyright © 2006 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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