scholarly journals Racial and Ethnic Disparities in Breast Cancer: A Collaboration Between the American College of Radiology Commissions on Women and Diversity and Breast Imaging

2021 ◽  
Author(s):  
Dana Smetherman ◽  
Kelly Biggs ◽  
Oluwadamilola M Fayanju ◽  
Scott Grosskreutz ◽  
Zahra Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Breast Imaging ◽  
White Women ◽  
Breast Cancer Mortality ◽  
Tumor Biology ◽  
Ethnic Disparities ◽  
The United States ◽  
Minority Women

Abstract Since the 1980s, the mortality rate from breast cancer in the United States has dropped almost 40%. The quality of life and survival gains from early detection and improved treatment have not been shared equally by all ethnic groups, however. Many factors, including social determinants of health, unequal access to screening and oncologic care, and differences in incidence, tumor biology, and risk factors, have contributed to these unequal breast cancer outcomes. As breast radiologists approach their own patients, they must be aware that minority women are disproportionately affected by breast cancer at earlier ages and that non-Hispanic Black and Hispanic women are impacted by greater severity of disease than non-Hispanic White women. Guidelines that do not include women younger than 50 and/or have longer intervals between examinations could have a disproportionately negative impact on minority women. In addition, the COVID-19 pandemic could worsen existing disparities in breast cancer mortality. Increased awareness and targeted efforts to identify and mitigate all of the underlying causes of breast cancer disparities will be necessary to realize the maximum benefit of screening, diagnosis, and treatment and to optimize quality of life and mortality gains for all women. Breast radiologists, as leaders in breast cancer care, have the opportunity to address and reduce some of these disparities for their patients and communities.

Racial and Ethnic Disparities in Breast Cancer Mortality: Are We Doing Enough to Address the Root Causes?

2006 ◽  
Vol 24 (14) ◽  
pp. 2170-2178 ◽  
Author(s):  
Dionne J. Blackman ◽  
Christopher M. Masi
Keyword(s):  
Breast Cancer ◽  
Health System ◽  
Cancer Mortality ◽  
White Women ◽  
Breast Cancer Mortality ◽  
Ethnic Disparities ◽  
The United States ◽  
System Level ◽  
Screening Tests ◽  
Racial And Ethnic Disparities

Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health system–level factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities.

scholarly journals Anxiety- and Health-Related Quality of Life Among Patients With Breast Cancer: A Cross-Cultural Comparison of China and the United States

2018 ◽  
pp. 1-9
Author(s):  
Jin You ◽  
Qian Lu ◽  
Michael J. Zvolensky ◽  
Zhiqiang Meng ◽  
Kay Garcia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
United States ◽  
Trait Anxiety ◽  
State Anxiety ◽  
Cultural Context ◽  
The United States ◽  
Cross Cultural ◽  
Chinese Patients

Purpose Literature has documented the prevalence of anxiety and its adverse effect on quality of life among patients with breast cancer from Western countries, yet cross-cultural examinations with non-Western patients are rare. This cross-cultural study investigated differences in anxiety and its association with quality of life between US and Chinese patients with breast cancer. Methods Patients with breast cancer from the United States and China completed measures for anxiety (Spielberger State-Trait Anxiety Inventory) and quality of life (Functional Assessment of Cancer Therapy-Breast). Results After controlling for demographic and medical characteristics, Chinese patients reported higher levels of trait and state anxiety than US patients. Although there was an association between anxiety and quality of life in both groups of patients, the association between state anxiety and quality of life was stronger among Chinese patients than among US patients, with the association between trait anxiety and quality of life the same between the two cultural samples. Conclusion These findings suggest that anxiety and its association with quality of life among patients with breast cancer varies depending on cultural context, which reveals greater anxiety and poorer quality of life among Chinese patients compared with US patients. This suggests greater unmet psychosocial needs among Chinese patients and highlights the need to build comprehensive cancer care systems for a better quality of life in Chinese populations.

More Than Just a Mammogram: Breast Cancer Screening Perspectives of Relatives of Women With Intellectual Disability

2014 ◽  
Vol 52 (6) ◽  
pp. 444-455 ◽  
Author(s):  
Nechama W. Greenwood ◽  
Deborah Dreyfus ◽  
Joanne Wilkinson
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Health Care ◽  
Intellectual Disability ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Breast Cancer Mortality ◽  
Family Members ◽  
Well Being

Abstract Women with intellectual disability (ID) have similar rates of breast cancer as the general public, but higher breast cancer mortality and lower rates of regular screening mammography. Screening rates are lowest among women who live with their families. Though women with ID often make decisions in partnership with their relatives, we lack research related to family member perspectives on mammography. We conducted a qualitative study of family members of women with ID, with an interview guide focused on health care decision making and experiences, and breast cancer screening barriers, facilitators, and beliefs as related to their loved ones. Sixteen family members underwent semistructured interviews. Important themes included mammography as a reference point for other social and cultural concerns, such as their loved one's sexuality or what it means to be an adult woman; fear of having to make hard decisions were cancer to be diagnosed acting as a barrier to screening; a focus on quality of life; and desire for quality health care for their loved one, though quality care did not always equate to regular cancer screening. Adults with ID are valued members of their families, and their relatives are invested in their well-being. However, families fear the potentially complicated decisions associated with a cancer diagnosis and may choose to forgo screening due to misinformation and a focus on quality of life. Effective interventions to address disparities in mammography should focus on adults with ID and their families together, and incorporate the family context.

scholarly journals A new paradigm of screening and early diagnosis: assessment of benefits and harms

2020 ◽  
Vol 66 (6) ◽  
pp. 589-602
Author(s):  
Давид Заридзе ◽  
Dmitry Maksimovich ◽  
Ivan Stilidi
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Prostate Cancer ◽  
Clinical Trials ◽  
Early Diagnosis ◽  
The United States ◽  
Diagnostic Methods ◽  
New Paradigm

Abstract The article presents scientific evidence that confirms the new paradigm that  “early” diagnosis is not always beneficial, and that screening and early diagnosis can do more harm than good. As a result, of screening, in a number of cases, lesions are diagnosed that, although have histological patterns of cancer, are often clinically insignificant, indolent i.e. overdiagnosis takes place. Such lesions primarily include latent cancers of the prostate and thyroid gland. An increase in the incidence of certain types of cancers in the United States and other developed countries, as a result, of the introduction of PSA screening, mammography, ultrasound examination of the neck and other highly sensitive diagnostic methods, with stable or decreasing mortality, is a sign of overdiagnosis. In Russia, there is also a marked increase in the incidence of cancer of the prostate, breast, thyroid, kidney and melanoma, while mortality from these forms of cancer is stable or decreasing. The increase in the incidence of all malignant formations in Russian, as in American men, is determined by the increase in the incidence of prostate cancer. In randomized clinical trials of the efficacy of screening for prostate and breast cancer, an excess of the detected cases of cancer in the screening group compared with the control group indicates overdiagnosis. With an increase in follow-up (10-15 years), the number of excess cases in the screening group decreases. However, in some studies even after 10-15 years of follow-up, the excess of cancer cases in the screening group persisted, i.e. overdiagnosis was confirmed. Thus, the problem of overdiagnosis is also relevant to controlled clinical trials, despite a well-verified protocol and strict adherence to it. The danger of overdiagnosis in real life, daily practice, and especially with opportunistic screening, which, by definition, is carried out without quality control, is much higher. Overdiagnosis often leads to unnecessary, sometimes excessive treatment and a deterioration in the quality of life of patients who are not cancer patients. Refusal of aggressive therapy and active follow-up should be the method of choice for the management of patients with asymptomatic neoplasms identified at the screening. Such tactics will avoid unnecessary and excessive interventions, which, in turn, will prevent a deterioration in the quality of life of patients and, in addition, will reduce the cost of treatment. Key words: overdiagnosis, screening, early diagnosis, trends in incidence and mortality, prostate cancer, breast cancer, thyroid cancer

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