AfricanAmericans Breast Cancer Survival Disparities

1
African-Americans Breast Cancer Survival
Disparities
a lack of racial Deathparity

• Harvey L. Bumpers, MD, FACS
• Professor
• Director of Surgical Oncology
• Department of Surgery, Morehouse School of
  Medicine

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Racial Deathparity

• Equivalent death rates across racial
• lines
• Aligning racial deathparity - refers to
  decreasing death rates (from breast cancer) to
  make it equivalent between racial groups (African
  Americans and Whites).

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Leading Causes of Death by Rank

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Cancer Mortality Rate Ratio
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Breast Cancer in African American Women

• New Breast Cancers 20,000 (13 less
• than Whites)
• Deaths from Breast Cancer 5,700
• 5 year survival 73 (88 whites)

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THE BREADTH OF THE PROBLEM
27 years old
18 years old
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Incident of Breast Cancer Ratio of African
American to Whites
2.0
1.5
1.4
1.1
1.0
Incident Rate (Ratio)
0.9
0.9
0.8
0.8
Age (yrs)
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Five Year Survival Rates
81.5
79.2
68.3
65.9
Survival
How do we increase survival in Blacks to achieve
racial deathparity?
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Poor Prognostic Predictors

• AA Whites
• Tumor size - 2.0cm 65.5 52.2
• Node Positive 57.2
  54.4
• Node with tumor lt 2.0cm 34.2
  28.5
• Hormone receptor Negative 66.7 52.4

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Death Rate Reduction from Breast Cancer Over the
Past 20 Years

• African Americans 0.4/year
• Whites 0.8/years

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Influences on Survival

• Stage at Diagnosis
• Available Early Healthcare
• Compliance with treatment
• Comorbidities
• Hormone Receptitivity
• Tumor Biology

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Survival By Stages

Whites
A.A.
5- year survival
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Why Disparities?????
Why a Lack of Deathparity?

• Socioeconomics
• Access to Healthcare
• Racial discrimination
• Cultural beliefs
• Psychology
• Tumor biology

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Socioeconomics

• Farley and Flannery, 1989
• Simon and Severson, 1996
• Concluded
• Low socioeconomic status was associated with late
  stage disease at presentation and poor survival
  compared with women of higher socioeconomic status

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Access to Healthcare

• Managed care programs (Roetzheim RG et al, 1999)
• Within the same managed care program controlling
  for disease stage, age, marital status African
  American women only had slightly poorer survival.
• Department of Defense ( Jatoi I et al, 2003)
• Breast cancer survival between African American
  and White women when adjusted for age and stage
  has continued to diverge
• (comparing 1980-1984, 1995-1999)

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Tumor Biology

• Race alone does account for some variability in
  
• survival
• Alterations in p53 more common in AA
• Histology and nuclear grade higher in AA
• C-met alterations higher in AA
• Mitochondrial DNA G10398A (Canter JA et al, 2005)
• Concluded that variation in the mitochondrial
  genome contributes
• to breast cancer susceptibility and that it may
  underlie differences
• in the incidence of breast cancer between
  African American and
• White women.

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Other Parameters Related to Racial Disparity and
the Lack of Racial Deathparity

• Cultural beliefs Unmarried Lack of private
  insurance
• Low Income Low educational
  level
• Poor neighborhoods Lack of
  Transportation

Less Screening
Increase in late disease at diagnosis
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Some Mechanisms to Eliminate Racial Disparity
and align Deathparity

• Education regarding lifestyle and cancer
• Early detection and screening
• Education regarding early detection and survival
• Increase use of annual mammography
• Baseline mammography closer to age 35
• than age 40 (A.A.)
• Work to dismiss the myths

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Conclusions

• Racial Disparities and the Lack of Deathparity
• Causes are Multifactorial
• and
• Necessitates a Multidisciplinary Approach