Possible Explanations for Racial Disparities
Subtle biological factors may play some role in the differences in mortality rates between different ethnic groups. This is not believed to be a major reason for these differences, however, and most of the attempts to discern underlying causes have focused on social, cultural, economic factors, or on factors affecting equal access to the health care system.
Some studies do seem to give clues about the different issues that may be influencing mortality discrepancies. For example, the earlier referenced University of North Carolina study found that while African-American women succumbed to all types of breast cancer more frequently than white women, the category where there was the biggest separation in mortality rates was with a type of breast cancer called Luminal A. Significantly, this type of breast cancer is considered to be the easiest to diagnose and treat, and yet African-American women have been dying from these cancers at a surprisingly high rate. This strongly suggests that access to prevention and proper treatment may be the problem, even for African-American women of higher socioeconomic status.
Backing this conclusion was a study done at the University of Michigan. It was discovered that among women whose cancer had spread to the lymph nodes, white women were three times more likely to have received chemotherapy, and five times more likely to have been given tamoxifen when its use would normally be recommended. Why exactly such gaps in treatment should exist is not well understood, but it appears to indicate that either clear communication between doctors and patients has been lacking, or that in some instances medical professionals have not been as diligent about recommending the best treatments available for African-American women as they should have been. One thing that has been noted anecdotally by many observers is that African-American women seem to have been underrepresented in clinical trials involving the most up-to-date and innovative methods of treatment.
There was one study done at the University of California-San Francisco in 2006 that found mammograms were the key factor explaining the racial discrepancy between white and black breast cancer mortality. When women had had the same number of screening mammograms in the same time period leading up to the eventual discovery of breast cancer, the survival rates between white women and African-American women were found to be essentially the same.
A Prescription for Change
The findings of these various studies seems to indicate that prevention and treatment for African-American women has lagged behind what it has been for white women, and also for Asian and Hispanic women. Part of the solution would appear to be a public relations campaign to raise awareness of the necessity for regular preventative mammograms to be performed. Also, it seems that the lines of communication between doctors and patients need to be improved to be sure that the best kinds of treatments are being used whenever this disease is diagnosed. Finally, it is incumbent upon the medical community to make sure everything is being done to recruit a broad range of participants for clinical trials involving the newest forms of breast cancer treatments.
It is certainly possible that hidden prejudices and biases of the most subtle type may be reflected in these mortality rate statistics. At the same time, more study needs to be done in order to understand why rates of mortality are lower in Asians and Hispanics, since these groups have historically been subject to exclusion and discrimination as well.
Ultimately, the medical profession must take it as a critical challenge to find ways to close the gap in breast cancer death rates between black women and white women, while continuing to do everything they can to lower the mortality rates from breast cancer for all women everywhere.
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