Public Health Democracy: U.S. and Global Health Disparities in Breast Cancer
In 2007, the National Cancer Institute issued a report indicating a decline in deaths from breast cancer. However, statistics on minority and underserved populations, especially African Americans (AAs), showed little or no change. Dr. Doris Browne in NCI’s Division of Cancer Prevention participated as a 2007 Woodrow Wilson Public Policy Scholar focusing on global breast cancer health disparities among African and AA women, specifically those who are at disproportionately greater risk of developing ER-negative breast cancer.
Migration patterns have been studied as possible contributors to the higher breast cancer mortality rates, particularly in those migrating from Africa to the U.S. African women tend to present with late stage aggressive breast cancer similar to that observed in young AA women. Other factors such as cultural beliefs, occupation, SES, environment, lifestyle and access to medical care play a role in breast cancer outcomes. Cancer has a significant impact on the U.S. economy; even with the reported decline in cancer mortality, the economic impact remains greater than that for other chronic diseases. Dr. Browne suggested that shifting to early detection, prevention and lifestyle changes could reduce cases, treatment costs and increase productivity. The absence of optimal screening practices in Africa is consistent with a diagnosis of late-stage disease. Mammography is a scarce resource and with no recommended screening guidelines women present with large tumors. Dr. Browne suggests the development of innovative strategies for preventing and treating breast cancer in order to reduce the disproportionate number of breast cancer in AAs.
Dr. Browne concluded that race does significantly impact cancer outcomes. AA women have a higher breast cancer mortality rate than non-Hispanic white (NHW) women, despite having lower incidence rates. Furthermore, AA women are diagnosed twice as often as NHWs with advanced stage breast cancer. Her recommendations include improving research focused on understanding the biology of ER-negative breast cancer, educating physicians on aggressive breast cancer (ER-negative) subtypes, and developing an ER-negative preclinical breast cancer model. Health policies supporting quality care should focus on consumers, providers, and the healthcare delivery system if an effective approach to eliminating disparities is to be achieved.
For additional information on Dr. Doris Browne’s project, you may view "Public Health Democracy: U.S. and Global Health Disparities in Breast Cancer".
