More than 1,700 black women die of breast cancer every year in the United States because of racial disparities in cancer risks and access to care, suggests a new study.
Researchers who calculated cancer death rates in 24 of the largest US cities found that in 13 of them, black women were significantly more likely to die of breast cancer than white women.
That's despite the evidence that white women are more likely than blacks to get breast cancer in the first place.
"It's unfortunate that this disparity exists and we all need to work hard to overcome it," said Marc Hurlbert, one of the researchers on the new study from the Avon Foundation for Women, which funded the report.
"The good news is it's a solvable problem, because some cities are doing better than others," he said.
Of the cities where black women were more likely to die of breast cancer, that disparity ranged from a 24 per cent higher risk of death in New York to more than twice the risk of death in Memphis between 2005 and 2007.
Other cities with racial disparities in deaths during those years included Los Angeles, Chicago, Houston, Philadelphia, San Diego, Dallas, Jacksonville, Columbus, Milwaukee, Boston and Denver.
On the other hand, there was no difference in black and white women's chances of dying from breast cancer in Phoenix, San Antonio, San Jose, Detroit, San Francisco, Austin, Baltimore, Fort Worth, Charlotte, El Paso and Seattle.
The researchers were missing data on breast cancer deaths in Indianapolis, the last of the 25 largest US cities.
Across the country, they calculated that black women were 40 per cent more likely to die of breast cancer than whites, adding up to 1,722 extra deaths each year due to racial disparities.
According to the Centers for Disease Control and Prevention, just over 40,000 women in the US died of breast cancer in 2007, the most recent year with available data.
Lower average family income in a city and more racial segregation by neighborhood were both tied to larger disparities in breast cancer deaths between black and white women, according to the new study, which was published Wednesday in Cancer Epidemiology.
That's probably because poor women in segregated areas can't easily get to facilities that screen for breast cancer or provide comprehensive treatment, the researchers said.
The United States Preventive Services Task Force recommends screening mammography every other year for women ages 50 to 74, with the option to start earlier based on a patient's own risks and preferences.
Health services "are just not easy to access if you're in those neighborhoods that are segregated," Hurlbert told Reuters Health.
"Some of the facilities that are in these poorer, more segregated areas just are inferior."
Many possible explanations
Sam Harper, who has studied racial differences in breast cancer diagnosis and survival at McGill University in Montreal, pointed out that there could be many reasons why black women die at a higher rate than white women in some cities.
That includes differences in how much alcohol women drink and how many of them are overweight, as well as disparities in how advanced women's cancers are when they're diagnosed.
"It's very difficult for a study like this to tell us about the potential causes for the variation in black-white mortality," Harper, who wasn't involved in the research, told Reuters Health.
Without that information, he added, it's hard for researchers and policy makers to know how to shrink the disparities in breast cancer deaths.
"We know that there are disparities in care, and that is a part of the reason for this," said David Williams, who studies racial differences in cancer at the Harvard School of Public Health in Boston and wasn't involved in the new study either.
"But it's not just disparities in care. We also know that African Americans get breast cancer at younger ages (and) get more severe types of breast cancers, so that when they are diagnosed they are frequently at a later stage of disease and their disease is more severe."
Researchers, he said, have looked into everything from hair products that black women use to the jobs they have and their nutrition as reasons they might be more at risk for severe disease.
Williams said the finding that there is some variation by city might be useful in that researchers and policy makers could learn from those areas with lower death rates and less disparity.
In addition, the study is "just another reminder that there's a lot of work to be done," he added. "In a country that values equality so strongly, we really need to make progress in ensuring that every American has access to the best quality health care."