Health Inequities in Breast Cancer Outcomes Between Black and White Women

Breast cancer is the second-leading cause of death among women in the United States and is the most diagnosed cancer among women. Breast cancer mortality rates have decreased rapidly in the last 30 years, for a total decline of almost 40% through 2015. Improvements in treatment and early detection through screening have contributed to the decline.

Historically, mammography screening rates among black women have been lower than among white women, and this statistic has been used as evidence for why Black women die from breast cancer at higher rates than white women; however, recent studies show that Black women are screened for breast cancer at a 5%–7% higher rate than white women.

Despite higher screening rates recently, Black women still have a lower 5-year national survival rate for breast cancer (80%) than white women (90%). The higher mortality rate may be because Black women are diagnosed with more advanced cancer than white women.

RTI International is partnering with CDC and state cancer registries in North Carolina, Texas, and California. This partnership will advance the evidence base around how screening history relates to the stage of breast cancer at diagnosis, and the findings will be used to explain racial inequities in breast cancer mortality between Black and white women.

Led by Dr. Pamela Spain, Director of RTI’s Program on Specialty Care for Seriously Ill Populations, the research team is partnering with three diverse state cancer registries to collect data about Black and white female breast cancer survivors and their stage at diagnosis.

In each state, white women have a higher incidence rate of breast cancer—yet Black women have a higher mortality rate. Research indicates that there are numerous reasons for this disparity, including the following:

• Insurance status
• Treatment decision-making
• Structural racism among health care providers
• Biological differences in cancer aggressiveness
• Inequities in availability of advanced cancer treatments

As part of this study, RTI is collecting survey responses from female breast cancer survivors to determine the average age of a patient’s first mammogram and patterns of repeat mammograms. These survey data allow our researchers to assess whether there is a relationship between screening age and screening history with stage at diagnosis. The survey also includes assessing racial inequities in the following areas:

• Mammogram use and access to health care, including perceived barriers to screening
• Attitudes and beliefs about breast cancer screening and the health care system, including perceived systemic racism from health care providers
• Family history of cancer
• Self-reported medical history, including use of hormones
• Impact of COVID-19 on personal needs and access to care, including whether breast cancer treatment or follow-up was delayed or canceled during the pandemic.

CDC will use this study’s results to inform interventions, recommendations, and communications to reduce disparities that Black women face related to mammogram access. Results from the COVID-19 analyses can be used to help prepare cancer patients, cancer centers, and other health care providers for a future national health crisis.