Breast Cancer Survival Disparities

When researchers look at data on survival rates between black and white women diagnosed with breast cancer, they find a rather significant disparity. White women tend to live longer after diagnosis than do black women. Racial disparities in cancer survival have been acknowledged for some time, though it is recognized that the reasons for this disparity are extremely complex.

In a recent study, researchers used data from Medicare beneficiaries to compare 7,375 black women with a breast cancer diagnosis to white women controls. In selecting controls, researchers looked to a very large pool of white women (99,898 potential controls).The large pool allowed for the careful selection of controls to match each  of the 7,375 cases. Controls were sought that had similar demographics, characteristics of the cancer at diagnosis, and general treatment details. By carefully matching cases to controls in this way, researchers were attempting to ensure that differences in outcomes were not the result of demographics, differences in cancer stage or treatment variables.

The researchers’ data suggest that, on average, white women survive three years longer than black women with a similar breast cancer diagnosis. The research found that black women were likely to receive lower quality care, if they received care at all. And yet, according to the research, differences in care and treatment do not account for the large disparity in survival rates. Rather, this appears to result from the fact that black women have more advanced stages of disease than do white women when first diagnosed. Black women in the study were significantly less likely to have seen a primary care doctor in the 6 to 18 months before diagnosis, and they had far lower rates of cholesterol and colon cancer screening, indicating a tendency toward less preventive care.

Interpretations and Implications

This study suggests that racial disparities in breast cancer survival may be directly related to access to, or utilization of, primary care services, including preventive care. It is important to note that all women were Medicare beneficiaries and therefore, had health coverage, so primary care utilization appears to be the principal difference. However, there may be a whole host of other factors affecting survival; researchers did not examine detailed differences in treatment. Nor did they account for potential differences in environmental exposures. Yet, their finding that black women seek care at later stages of disease does have a number of implications for programs designed to educate communities, and providers, about the importance of primary care and basic awareness. By evaluating survival difference, researchers focused on an important outcome, as survival is the ultimate aim of treatment. To ensure that black women are surviving as long as white women, more research is needed to fully understand the complex disparity. 

Source: Silber et al. 2013. “Characteristics associated with differences in survival among black and white women with breast cancer,” Journal of the American Medical Association [310(4):389-97].

jess Werder headshot BWJessica Werder, Health Researcher, Community Outreach Manager

Jess Werder earned an M.P.H. from State University of New York (SUNY) at Albany, is Community Outreach Manager for the Fairfax County Health Department in Virginia. With the Peace Corps in Nicaragua from 2008-2010, she was a Community Health Promoter whose responsibility was to design, implement and evaluate department-wide community health programs, then, on her return to the States, continued this work with the Association of Farmworker Opportunity Programs (AFOP). She was a graduate fellow at the SUNY Center for Women in Government and a Lecturer in the Department of Women’s Studies at U Albany. She now lives in the Washington, DC area with her husband and two young children. Jess currently researches and writes the “Recent Research” column for Capital Region Action Against Breast Cancer! (CRAAB!), a community-based non-profit created in 1997 by a diverse group of caregivers, health practitioners, educators, advocates and breast cancer survivor. BCC is pleased to republish some of these insightful analyses in our own Research Briefs.

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