A community approach to addressing excess breast and cervical cancer mortality among women of African descent in Boston

Abstract

Black women in the U.S. have excess mortality from breast and cervical cancer, compared with white women.For 1996-1998, the age-adjusted breast cancer death rate among black women in the U.S. was 26.2/100,000, compared with 19.0/100,000 for white women. 1 For 1990-1994, the age-adjusted cervical cancer death rates were 5.9/100,000 for black women and 2.4/100,000 for white women. 2 Studies comparing rates of mammography screening and breast cancer mortality for black and white women in the early 1990s determined that less than 15% of the variance could be attributed to screening. 3In 1998, the mortality rate from breast cancer was 40% higher among black women in Boston than among white women (Unpublished data, Boston resident deaths, Massachusetts Department of Public Health, analyzed by the Office of Research, Health Assessment and Data Systems, Boston Public Health Commission).For the time period 1995-1997, three times as many black women died from cervical cancer as white women.In Massachusetts, black women reported higher rates of breast and cervical cancer screening than white women on the Massachusetts Behavioral Risk Factor Surveillance Survey (BRFSS) (Unpublished 1992-1998 BRFSS data, Massachusetts Department of Public Health, analyzed by the Office of Research, Health Assessment and Data Systems, Boston Public Health Commission).The disparity in breast and cervical cancer deaths, therefore, does not appear to be solely attributed to lack of screening.Several factors have been proposed to account for the disproportionately high rates of breast cancer deaths among black women.For example, McCarthy et al. reported that older black women have less regular mammography screening than older white women. 3Factors that may contribute to higher death rates among black women are delayed diagnosis, differences in tumor biology, confounding comorbid and socioeconomic conditions, 4 and personal beliefs about cancer and mammography among black women. 5,6Recent data suggest that black women have a higher incidence of and more aggressive breast cancers before the age of 40 than white women in the same age range. 7ervical cancer disparities have been attributed to multiple factors.The lack of follow-up of abnormal Pap smears due to women's fear of cancer, concern for reproductive function, and fear of pain 8 ; logistical barriers (transportation, child care); and lack of understanding of the implications of abnormal results 9 are among the reasons cited for higher mortality from cervical cancer among black women than among white women.Addressing high rates of breast and cervical cancer mortality among black women in Boston requires an Public Health Reports / July