Deaths nearly 40% higher than for white women, pegged to lower access to care
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SAN ANTONIO – Black women die of breast cancer at rates nearly 40% higher than white women, despite having lower instances of the disease, because of racial disparities in care, according to a New England Journal of Medicine article by a UT Health San Antonio surgical oncologist and two American Cancer Society scientists.
The authors, led by Ismail Jatoi, MD, PhD, FACS, professor of surgical oncology and endocrine surgery at UT Health San Antonio’s Mays Cancer Center, trace the start of the disparity to the 1980s with the introduction of medical interventions disproportionately available to white populations.
That disparity persists, as indicated in a review of incidence and mortality from 2014 through 2018 that shows markedly higher rates of so-called triple-negative, or highly aggressive, forms of the cancer in Black women.
“We believe supporting research on the prevention and treatment of triple-negative breast cancer should be a national priority, since such research will be essential for mitigating racial disparities in outcomes and reducing global breast-cancer mortality,” the authors write.
“Because overall breast-cancer incidence remains lower among Black women than among white women in the United States, ensuring universal access to high-quality medical care can substantially narrow the racial disparity in U.S. breast-cancer mortality.”
The ”Perspective” article was posted online June 18 for the June 23 publication of the prestigious journal, titled, “The Emergence of the Racial Disparity in U.S. Breast-Cancer Mortality.” Dr. Jatoi is lead author. American Cancer Society authors include Hyuna Sung, PhD, principal scientist, Cancer Surveillance Research; and Ahmedin Jemal, DVM, PhD, senior vice president, Surveillance & Health Equity Science.
“The article by Dr. Jatoi and colleagues highlights a critical need to decrease cancer health disparities, a key focus of the Mays Cancer Center over its 48-year history focusing on the cancer issues of South Texas and our Latino minority majority,” said Ruben Mesa, MD, FACP, executive director of the Mays Cancer Center, one of four National Cancer Institute-designated Cancer Centers in Texas.
According to the article, breast cancer deaths among Black women stood at 27.7 per 100,000 women in 2014-2018, compared to 20.0 deaths per 100,000 white women – 38.5% greater. This, despite lower overall incidence of the disease among Black women: 125.8 cases compared with 139.2 cases per 100,000 women.
Prior to 1980, breast cancer mortality for Black women was slightly lower than for white women. The ‘80s, the article notes, brought two medical interventions for breast cancer management – mammography screening, and adjuvant endocrine therapy that targets tumors.
“A troubling consequence of the implementation of these medical interventions, however, was the emergence of a large racial disparity in breast-cancer mortality in the United States,” the article says.
As Black women are more likely than white women to lack health insurance or have inadequate coverage, their access to mammography screening and therapeutics has been limited, according to the article.
While mammography rates have improved, the screening along with endocrine therapy primarily benefit patients with hormone receptor (HR)-positive breast cancer, the most common subtype.
However, recent data cited in the article shows that Black patients have a 65% higher rate of HR-negative breast cancer – more serious than HR-positive subtypes. And they show a 81% higher rate of the most aggressive triple HR-negative forms. Mortality for HR-negative breast cancer is more than twice as high among Black women as among white women
On balance, then, Black women have derived less benefit from the introduction of mammography screening and adjuvant endocrine therapy than white women, the authors write, and they have substantially higher rates of HR-negative tumors, which generally carry a poorer prognosis.
“Removing barriers to health care access could therefore mitigate the racial divide in breast-cancer mortality,” they conclude.
Ismail Jatoi, MD, PhD; Hyuna Sung, PhD; and Ahmedin Jemal, DVM, PhD
First posted: June 18, 2022, New England Journal of Medicine (nejm.org)
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