Breast Cancer Awareness Month: Leave No One Behind
Breast cancer is still the most common form of cancer in women worldwide. One in eight women in the U.S. faces a breast cancer diagnosis in her lifetime. And due to health inequities, minorities and other underserved populations face a grimmer outcome from breast cancer than non-Hispanic white individuals.
October is Breast Cancer Awareness Month. An annual campaign where the goal is to get involved in raising awareness and raising funds for life-saving research and life-changing support.
An emphasis is placed on how to attain health equity. Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
Let's explore some of the social determinants of health (SoDH) that influence health equity among those with breast cancer.
Breast Cancer and SoDH
Some factors impact how likely a woman is to develop breast cancer and the aggressiveness of their disease. These factors, called social determinants of health (SoDH), including where a person lives, works, and plays can influence health outcomes. Additional factors include:
- Racial discrimination
- Limited access to the healthcare system, including affordable and adequate insurance coverage and access to high-quality healthcare
- Inadequate pay and lack of paid time off from work for medical care
- Lack of access to healthy and affordable foods
- Lack of transportation that is accessible, affordable, and reliable
- Lack of safe, stable, and affordable housing
There are some specific SoDH that impact rural populations. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers and geographic distance from medical facilities. Travel distance to treatment centers is the most substantial barrier to improved breast cancer outcomes in rural areas.
Differences by race and ethnicity
Some variations in breast cancer can be seen between racial and ethnic groups. For example, unequal access to improvements in breast cancer treatment may explain the differences in survival rates between African American and White women.
Here are some more revealing facts about the disparity between races:
- According to the most recent data available, breast cancer mortality is about 40 percent higher for African-American women in the U.S. than Caucasian women.
- The higher mortality rate may be because about 1 in 5 Black women with breast cancer have triple-negative breast cancer (TNBC) more than any other racial/ethnic group. TNBC differs from other types of invasive breast cancer in that it tends to grow and spread faster, has fewer treatment options, and tends to have a worse outcome.
- African-American women are often diagnosed with breast cancer in late stages when treatment options are limited, costly, and the prognosis is poor.
- At every age, Black women are more likely to die from breast cancer than any other race or ethnic group.
- As of 2019, breast cancer became the leading cause of cancer death for Black women.
Differences between rural and urban populations
Rural areas were found to have lower rates of new breast cancer diagnoses compared to urban areas.
However, while rural areas have a lower incidence of cancer than urban areas, they have higher cancer death rates. The differences in death rates between rural and urban areas are increasing over time.
Mammography screening use rates are slightly lower among rural women than their urban counterparts, with a corresponding increase in late-stage breast cancer.
Differences in breast cancer survival persist after controlling for a stage at diagnosis, largely due to disparities in access to treatment.
While numerous interventions have been demonstrated in controlled studies to be effective in promoting treatment access and adherence, widespread dissemination of these interventions in public health and clinical practice remains lacking.
Efforts to improve breast cancer
Public Health Efforts to End Disparities
The following are recommendations to address disparities toward equitable opportunity for all populations.
- Create statewide screening programs
- Address the biological differences in breast cancer across racial and ethnic groups.
- Expand Black women’s participation in breast cancer research to determine some of the underlying biologies to explain the higher incidence of aggressive tumors in Black women and to identify biomarkers that could ultimately inform personalized therapies and improve outcomes.
- Develop culturally sensitive interventions.
- Conduct research on the unique psychological experiences of Black women diagnosed with breast cancer to develop tools that can help them better cope.
- Use telehealth to broaden the reach of rural populations.
- Improve dissemination of evidence-based information to rural oncology providers.
- Provide guidance on cutting-edge therapies available based on patient, disease, and tumor characteristics.
- Offer an evidence-based self-management intervention to rural patients.
The following goal of the Breast Cancer Research Foundation succinctly encapsulates how to close the disparities gap:
“A deeper understanding of tumor biology, its variations among people of different races, and the intersection of biology and social determinants of health holds the promise to improve prevention strategies, early detection, and treatment of breast cancer to reduce disparities.”
Research and materials for this article were compiled, written, and distributed on behalf of the National Public Health Information Coalition. The views and opinions expressed in this blog are those of the various authors and do not necessarily reflect the official policy or position of the National Public Health Information Coalition or its members.