Excess Burden of Morbidity and Mortality
The United States
In the United States, non-Hispanic White women have the highest incidence rate of breast cancer while Black women have the highest breast cancer mortality rate. It is widely held that the excess mortality is largely due to the lack of availability and/or accessibility of health care resources. Research looking at breast and then prostate cancer done at the National Cancer Institute, reported that equal treatment resulted in equal outcomes.20
However, there are growing data that suggest that access to early, regular and appropriate cancer screening, detection, and treatment, likely explains only part of the burden of excess mortality.2, 5, 6, 21California
In California, breast cancer remains the most commonly occurring invasive cancer diagnosed among women. Between 1995 and 1999, the most recent five-year period for which data are available, among women under 50 years of age, the average incidence rate of newly diagnosed in-situ or invasive breast cancer, was 48/100,000 (52.7/100,000 for non-Hispanic White women, 48.4/100,000 for Black women, 46.3/100,000 for Asian/Pacific Islander women, and 35.2/100,000 for Latinas). Among women 50 years of age or older, the average incidence rate of newly diagnosed in-situ or invasive breast cancer, was 426.2/100,000 (484.1/ 100,000 for non-Hispanic White women, 372.8/100,000 for Black women, 265.4/100,000 for Asian/Pacific Islander women, and 256.9100,000 for Latinas). During the same period of time, the breast cancer mortality rates among California women had a different racial profile. The age-adjusted breast cancer mortality rate among all California women was 26.4/100,000 (28.9/100,000 for non-Hispanic White women, 35.8/100,000 for Black women, 14.4/100,000 for Asian/Pacific Islander women, and 18.0/100,000 for Latinas).1 When looking at trends of these rates, each of these reported incidence and mortality rates is lower for each population than the immediately two previous time periods, except for Asian/Pacific Islander women, whose incidence and mortality rates have increased over the last eleven years.
As is true for the United States, despite an overall decline in breast cancer mortality in California, racial and ethnic disparities persist. While the incidence of breast cancer among Black women is lower than in non- Hispanic White women, Black women continue to die of breast cancer at a higher rate than any other racial or ethnic group. While it is important that we as scientists, clinicians, and survivors focus our attention on the eradication of breast cancer for all women, I believe that we have an additional moral imperative to address the increased burden of mortality due to breast cancer among African American women.
