Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–2009

November 16, 2012

Black women are 40% more likely to die of breast cancer than other women.
Implementing effective interventions, such as promoting timely follow-up after abnormal mammograms, using patient navigators, and providing high quality treatment, can help reduce breast cancer deaths.
CDC's National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured, and underinsured women access to timely breast and cervical cancer screening and diagnostic services.

Learn Vital Information on breast cancer. Learn more. CDC Vital Signs www.cdc.gov/VitalSigns

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Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–2009

Weekly
November 16, 2012 / 61(45);922-926

On November 14, 2012, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).

Abstract

Background: Breast cancer death rates have been declining among U.S. women since 1990 because of early detection and advances in treatment; however, all racial groups have not benefited equally.
Methods: Breast cancer incidence, stage at diagnosis, and mortality rates for 2005–2009 for women in the United States and for each state were calculated using United States Cancer Statistics (USCS) data. Black to white mortality ratios and mortality to incidence ratios by race were calculated.
Results: Despite having lower incidence rates, black women had a 41% higher breast cancer death rate. More black women were diagnosed at regional or distant cancer stage compared with white women (45% versus 35%). For every 100 breast cancers diagnosed, black women had nine more deaths than white women (27 deaths per 100 breast cancers diagnosed among black women compared with 18 per 100 among white women).
Conclusions: Despite significant progress in breast cancer detection and treatment, black women experience higher death rates even though they have a lower incidence of breast cancer compared to white women.
Implications for Public Health Practice: Advances in screening and treatment have improved survival for U.S. women with breast cancer. However, black women experience inequities in breast cancer screening, follow-up, and treatment after diagnosis, leading to greater mortality. At the individual level, the maximal effectiveness of screening for breast cancer can only be achieved when all women have timely follow-up to breast cancer exams and state-of-the-art treatment. At the health system level, optimal health-care delivery may be strengthened through performance-based reimbursement, expanded use of information technology, and quality assurance reporting-protocols. Proven effective interventions such as patient navigation could be expanded for use in other settings.

Understanding Mammograms

What is a mammogram?

A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer.

Why should I get a mammogram?

Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt. When their breast cancer is found early, many women go on to live long and healthy lives.

When should I get a mammogram?

Women should have mammograms every two years from age 50 to 74 years. Talk to your health professional if you have any symptoms or changes in your breast, or if breast cancer runs in your family. He or she may recommend that you have mammograms before age 50 or more often than usual.

How is a mammogram done?

You will stand in front of a special X-ray machine. A technologist will place your breast on a clear plastic plate. Another plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is being taken. You will feel some pressure. The other breast will be X-rayed in the same way. The steps are then repeated to make a side view of each breast. You will then wait while the technologist checks the four X-rays to make sure the pictures do not need to be re-done. Keep in mind that the technologist cannot tell you the results of your mammogram.

What does having a mammogram feel like?

Having a mammogram is uncomfortable for most women. Some women find it painful. A mammogram takes only a few moments, though, and the discomfort is over soon. What you feel depends on the skill of the technologist, the size of your breasts, and how much they need to be pressed. Your breasts may be more sensitive if you are about to get or have your period.

Before you get a mammogram, you may want to ask the following questions—

What will happen? How long will I be there?
Do you have my previous mammograms?
When will my doctor get the results?
When and how will I learn about the results?
When will I need to have my next mammogram?

What does a mammogram look like?

An example of a normal mammogram is shown here. Each woman's mammogram may look a little different because all breasts are a little different. A doctor with special training, called a radiologist, will read the mammogram. He or she will look at the X-ray for early signs of breast cancer or other problems.

When will I get the results of my mammogram?

You will usually get the results within a few weeks, although it depends on the facility. A radiologist reads your mammogram and then reports the results to you or your doctor. If there is a concern, you will hear from the mammography facility earlier. Contact your health professional or the mammography facility if you do not receive a report of your results within 30 days.

Tips for getting a mammogram—

Try not to have your mammogram the week before you get your period or during your period. Your breasts may be tender or swollen then.
On the day of your mammogram, don't wear deodorant, perfume, or powder. These products can show up as white spots on the X-ray.
Some women prefer to wear a top with a skirt or pants, instead of a dress. You will need to undress from your waist up for the mammogram.

What happens if my mammogram is normal?

Continue to get regular mammograms. Mammograms work best when they can be compared with previous ones. This allows your doctor to compare them to look for changes in your breasts.

What happens if my mammogram is abnormal?

If it is abnormal, do not panic. An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems.

Where can I get a mammogram and who can I talk to if I have questions?

If you have a regular doctor, talk to him or her.
Call the National Cancer Institute's Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237). For TTY: 1-800-332-8615.
For Medicare information, you can call 1-800 MEDICARE (1-800-633-4227) or visit The Centers for Medicare and Medicaid Services.
The Centers for Disease Control and Prevention (CDC) has a program called the National Breast and Cervical Cancer Early Detection Program, which works with health departments and other groups to provide low-cost or free mammograms to women who qualify. Find out if you qualify.

CRCHD - What Are Patient Navigators?

What Are Patient Navigators?

Patient Navigators are trained, culturally sensitive health care workers who provide support and guidance throughout the cancer care continuum. They help people "navigate" through the maze of doctors' offices, clinics, hospitals, outpatient centers, insurance and payment systems, patient-support organizations, and other components of the health care system. Services are designed to support timely delivery of quality standard cancer care and ensure that patients, survivors, and families are satisfied with their encounters with the cancer care system. Patient Navigator activities designed to achieve these outcomes include:

Coordinating appointments with providers to ensure timely delivery of diagnostic and treatment services.
Maintaining communication with patients, survivors, families, and the health care providers to monitor patient satisfaction with the cancer care experience.
Ensuring that appropriate medical records are available at scheduled appointments.
Arranging language translation or interpretation services.
Facilitating financial support and helping with paperwork.
Arranging transportation and/or child/elder care.
Facilitating linkages to follow-up services.

Other Navigator activities include community outreach, providing access to clinical trials, and building partnerships with local agencies and groups (e.g., referrals to other services and/or cancer survivor support groups).
CRCHD - What Are Patient Navigators?

Treatment

Surgery. An operation where doctors cut out and remove cancer tissue.
Chemotherapy. Using special medicines, or drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.
Hormonal therapy. Some cancers need certain hormones to grow. Hormonal treatment is used to block cancer cells from getting the hormones they need to grow.
Biological therapy. This treatment works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.
Radiation. The use of high-energy rays (similar to X-rays) to kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

It is common for doctors from different specialties to work together in treating breast cancer. Surgeons are doctors that perform operations. Medical oncologists are doctors that treat cancers with medicines. Radiation oncologists are doctors that treat cancers with radiation.

For more information, visit the National Cancer Institute (NCI) – Breast Cancer Treatment Option Overview.

This site can also help you find a doctor or treatment facility

that works in cancer care. Visit Facing Forward: Life After Cancer Treatment

for more information about treatment and links that can help with treatment choices.

Clinical Trials

If you have breast cancer, you may want to take part in a clinical trial. Clinical trials study new treatment options to see if they are safe and effective. Visit the sites listed below for more information about clinical trials.

NIH Clinical Research Trials and You (National Institutes of Health)
Educational Materials About Clinical Trials (National Cancer Institute)
Search for Clinical Trials (National Cancer Institute)
ClinicalTrials.gov (National Institutes of Health)

Complementary and Alternative Medicine

Complementary medicine is a group of medicines and practices that may be used in addition to the standard treatments for cancer. Alternative medicine means practices or medicines that are used instead of the usual, or standard, ways of treating cancer. Examples of complementary and alternative medicine are meditation, yoga, and dietary supplements like vitamins and herbs.
Complementary and alternative medicine does not treat breast cancer, but may help lessen the side effects of the cancer treatments or of the cancer symptoms. It is important to note that many forms of complementary and alternative medicines have not been scientifically tested and may not be safe. Talk to your doctor

before you start any kind of complementary or alternative medicine.

For more information about complementary and alternative medicine, visit the National Cancer Institute's Complementary and Alternative Medicine.

Which Treatment Is Right for Me?

Choosing which kind of treatment is right for you may be hard. If you have breast cancer, be sure to talk to your doctor about the treatment options available for your type and stage of cancer. Doctors can explain the risks and benefits of each treatment and their side effects.
Sometimes people get an opinion from more than one breast cancer doctor. This is called a "second opinion." Getting a second opinion

may help you choose the treatment option that is right for you.
For more information, visit the American Cancer Society's Breast Cancer

Web site.
CDC - Breast Cancer Treatment

CDC - National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 12 tribes.

Features

Partnership Development Toolkit
The toolkit helps NBCCEDP grant recipients maintain, grow, and develop new partnerships with many types of organizations.
NBCCEDP 20th Anniversary

20 Years of Screening Women and Saving Lives
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NBCCEDP Screening Program Data
Results from the NBCCEDP, representing breast and cervical cancer screening services provided to program-eligible women, are reported.
Map of the United States

Find a Screening Provider
The NBCCEDP provides screenings and diagnostic services to low-income, uninsured, and underinsured women.

New Directions for Cancer Screening

Health care reform through the Affordable Care Act gives CDC an opportunity to embrace new roles that build on the extensive clinical network of the NBCCEDP. Read more