Breast cancer is the second most common cancer among women and the second leading cause of cancer death among women in the United States.[1] In 2019, an estimated 268,600 individuals were newly diagnosed with invasive breast cancer.[1] There are currently an estimated 3.8 million breast cancer survivors in the United States,[1] and this number is expected to grow to 4.9 million in the next 10 years given steady or increasing incidence and decreasing mortality.[2] Overall, the 5-year breast cancer survival rate is 90%, and recent advances in detection and improvements in treatment suggest that many may exceed 5-year survival estimates. That being said, these advancements disproportionately benefit White women compared to women of color.[1]
Despite decades of research and interventions, significant racial and socioeconomic disparities in breast cancer mortality persist. While breast cancer incidence rates are higher among White women, breast cancer death rates are 37% higher among Black women compared to White women across the United States.[3] A study by Williams & Thompson (2017) found that the odds of late-stage breast cancer were significantly higher among African-American women compared to White women; in addition, the odds of late-stage breast cancer were higher among women residing in high-poverty areas compared to those living in low-poverty areas.[4] Among women of color, those who are low-income have lower rates of breast cancer screening and higher rates of late-stage diagnosis,[4, 5, 6] and are less likely to have health insurance or adequate health insurance coverage.[7, 8, 9] Furthermore, women living in low-income neighborhoods face barriers to accessing breast cancer screening and treatment services, including distance from healthcare facilities and lack of transportation [10, 11, 12] as well as limited financial resources.[13] In addition, low income women of color also have a higher prevalence of comorbidities (diabetes, hypertension, obesity)[14] and are more likely to have experienced previous discrimination in healthcare settings that may influence medical distrust and delay/avoidance of care [15].
We are motivated by the well-documented racial/ethnic and socioeconomic disparities in breast cancer screening, treatment, and outcomes. We are interested in identifying specific subgroups and geographic areas that may experience barriers to breast cancer screening and disparities in breast cancer mortality.
The goals of our project are the following:
At the city level for all 500 cities featured in the 500 Cities Project, we are interested in conducting an in-depth exploration of mammography use and breast cancer mortality rates as well as facilities offering mammography services.
At the national and census tract level (within the city of New York), we are interested in examining potential social and structural determinants of mammography use by examining its relationship with factors such as obesity, diabetes, insurance status, income inequality, racial/ethnic diversity, % high school completion and so on.
American Cancer Society. Cancer Treatment & Survivorship Facts and Figures 2019-2021. American Cancer Society; 2019.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of Cancer Incidence in the United States: Burdens Upon an Aging, Changing Nation. JCO. 2009 Jun 10;27(17):2758-65.
Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M. Trends in Breast Cancer by Race and Ethnicity: Update 2006. CA Cancer J Clin. 2006;56(3):168-83.
Williams F & Thompson E. Disparities in Breast Cancer Stage at Diagnosis: Importance of Race, Poverty, and Age. J Health Dispar Res Pract. 2017;10(3):34-45.
Schootman M, Jeffe DB, Lian M, Gillanders WE, Aft R. The Role of Poverty Rate and Racial Distribution in the Geographic Clustering of Breast Cancer Survival Among Older Women: A Geographic and Multilevel Analysis. Am J Epidemiol. 2009;169(5):554-61.
MacKinnon JA, Duncan RC, Huang Y, Lee DJ, Fleming LE, Voti L, Rudolph M, Wilkinson JD. Detecting an Association between Socioeconomic Status and Late Stage Breast Cancer Using Spatial Analysis and Area-Based Measures. Cancer Epidemiol Biomarkers Prev. 2007;16(4):756-62.
Byrne SK, Mary ES, DeShields T. Factors Associated with why African-American Women from One Urban County Use Mammography Services Less. J Natl Black Nurses Assoc. 2011;22(1):8-14.
Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, Siegel R, Stewart A, Jemal A. Association of Insurance with Cancer Care Utilization and Outcomes. CA Cancer J Clin. 2008;58(1):9-31.
Ko NY, Hong S, Winn RA, Calip GS. Association of Insurance Status and Racial Disparities with the Detection of Early-Stage Breast Cancer. JAMA Oncol. 2020;6(3):385-392.
Alexandraki I & Mooradian AD. Barriers Related to Mammography Use for Breast Cancer Screening among Minority Women. J Natl Med Assoc. 2010;102(3):206-18.
Mishra SI, DeForge B, Barnet B, Ntiri S, Grant L. Social Determinants of Breast Cancer Screening in Urban Primary Care Practices: A Community-Engaged Formative Study. Womens Health Issues. 2012;22(5):e429-38.
Barry J & Breen N. The Importance of Place of Residence in Predicting Late-Stage Diagnosis of Breast or Cervical Cancer. Health & Place. 2005;11(1):15-29.
Fernandez ME, Palmer RC, Leong-Wu CA. Repeat Mammography Screening among Low-Income and Minority Women: A Qualitative Study. Cancer Control. 2005;12 Suppl 2:77-83.
Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D. Comorbidity and Survival Disparities among Black and White Patients with Breast Cancer. JAMA. 2005;294(14):1765-72.
Burgess DJ, Ding Y, Hargreaves M, van Ryn M, Phelan S. The Association between Perceived Discrimination and Underutilization of Needed Medical and Mental Health Care in a Multi-Ethnic Community Sample. J Health Care Poor Underserved. 2008;19(3):894-911.