Disparities in mortality‐to‐incidence ratios by race/ethnicity for female breast cancer in New York City, 2002‐2016

Abstract

Background Racial disparities in New York City (NYC) breast cancer incidence and mortality rates have previously been demonstrated. Disease stage at diagnosis and mortality‐to‐incidence ratio (MIR) may present better measures of differences in screening and treatment access. Racial/ethnic trends in NYC MIR have not previously been assessed. Methods Mammogram rates were compared using the NYC Community Health Survey, 2002‐2014. Breast cancer diagnosis, stage, and mortality were from the New York State Cancer Registry, 2000‐2016. Primary outcomes were MIR, the ratio of age‐adjusted mortality to incidence rates, and stage at diagnosis. Joinpoint regression analysis identified significant trends. Results Mammogram rates in 2002‐2014 among Black and Latina women ages 40 and older (79.9% and 78.4%, respectively) were stable and higher than among White (73.6%) and Asian/Pacific‐Islander women (70.4%) (P < .0001). There were 82 733 incident cases of breast cancer and 16 225 deaths in 2000‐2016. White women had the highest incidence, however, rates among Black, Latina, and Asian/Pacific Islander women significantly increased. Black and Latina women presented with local disease (Stage I) less frequently (53.2%, 57.6%, respectively) than White (62.5%) and Asian/Pacific‐Islander women (63.0%). Black women presented with distant disease (Stage IV) more frequently than all other groups (Black 8.7%, Latina 5.8%, White 6.0%, and Asian 4.2%). Black women had the highest breast cancer mortality rate and MIR (Black 0.25, Latina 0.18, White 0.17, and Asian women 0.11). Conclusions More advanced disease at diagnosis coupled with a slower decrease in breast cancer mortality among Black and Latina women may partially explain persistent disparities in MIR especially prominent among Black women. Assessment of racial/ethnic differences in screening quality and access to high‐quality treatment may help identify areas for targeted interventions to improve equity in breast cancer outcomes.

Health Disparities in Patients Seeking Physiological Surgical Treatment for Lymphedema

“…In recent years, more light has been shed on the inherent disparities that exist within the health care system in the United States. These inequalities have been well documented in the [8][9][10] Socioeconomic status and race have also been shown to correlate with treatment delays for women with breast cancer. 15 These discrepancies are thought to be attributable in part to lack of access to early screening and early diagnosis and lack of appropriate screening intervals in disadvantaged populations.…”

“…Multiple studies have shown that Black and Latino patient populations have more advanced disease at initial diagnosis of breast cancer as compared with White women, in addition to a slower decrease in disease-related mortality over time. 8–10 Socioeconomic status and race have also been shown to correlate with treatment delays for women with breast cancer. 15 These discrepancies are thought to be attributable in part to lack of access to early screening and early diagnosis and lack of appropriate screening intervals in disadvantaged populations.…”

“…15 These discrepancies are thought to be attributable in part to lack of access to early screening and early diagnosis and lack of appropriate screening intervals in disadvantaged populations. 10,11 In one study, patients treated in a military health care system, in which access to care was equivalent in all racial populations, were found to have no significant differences in grade, stage, or size of tumor at breast cancer diagnosis. 11 This suggests that equal access to screening and treatment for patients of all racial and socioeconomic backgrounds may eliminate health disparities in breast cancer.…”

“…[1][2][3][4][5][6] Previous studies have reported on racial disparities in breast cancer diagnosis and treatment as well as incidence of secondary lymphedema occurrence. [7][8][9][10] These studies discuss a higher incidence of secondary lymphedema in Black women when compared with White women after treatment for breast cancer, potentially because of reduced access to screening and treatment, including population disparities in sentinel lymph node biopsy versus axillary lymph node dissection. 11,12 However, no studies to date have evaluated disparities in patients specifically seeking surgical consultation for physiological lymphedema treatment.…”

Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

“…Regarding race/ethnicity, it was recently determined to be associated with the prognosis of breast cancer ( 36 – 39 ). Especially, young black women with breast cancer had more adverse pathological factors and worse prognosis, when compared with white or Asian women.…”