Hirschman Jocelyn, Whitman Steven, Ansell David
Sinai Urban Health Institute, Sinai Health System, Mount Sinai Hospital, Room K430, 1500 South California Avenue, and Rush University Medical Center, Chicago, IL 60608, USA.
Cancer Causes Control. 2007 Apr;18(3):323-33. doi: 10.1007/s10552-006-0102-y. Epub 2007 Feb 6.
The black:white disparity in breast cancer mortality has been increasing in the U.S. In order to gain insight into this disparity in Chicago, we examined mortality data together with other important measures associated with breast cancer.
Trends in black:white female breast cancer mortality, incidence, stage at diagnosis, and mammography screening in Chicago were examined using data from the Illinois State Cancer Registry, Illinois Department of Public Health Vital Records, and the Illinois Behavioral Risk Factor Surveillance System.
The breast cancer mortality rate for black women in Chicago for 1999-2003 was 49% higher than that of white women, but the disparity is a recent phenomenon that is increasing rapidly. In 2003 the black rate was 68% higher than the white rate. Mortality rates were similar in the 1980's and only started to diverge in the 1990's as a result of a sharp improvement in mortality among white women contrasted with no improvement for black women. This lack of progress for black women is perplexing given that self-reported mammography screening rates have been the same for blacks and whites in Chicago since at least 1996 and that the early detection of breast cancer for black women has been increasing.
There has been no improvement in mortality from breast cancer for black women in Chicago in 23 years. This study, along with a review of the literature, lends support to the hypothesis that the disparities in breast cancer mortality are due to differential access to mammography, differential quality in mammography, and differential access to treatment for breast cancer. Fortunately, all three are amenable to intervention, which would help ameliorate this unacceptable disparity.
美国乳腺癌死亡率方面的黑人与白人差异一直在增加。为深入了解芝加哥的这一差异，我们对死亡率数据以及与乳腺癌相关的其他重要指标进行了研究。
利用伊利诺伊州癌症登记处、伊利诺伊州公共卫生部门生命记录以及伊利诺伊州行为风险因素监测系统的数据，研究了芝加哥黑人与白人女性乳腺癌死亡率、发病率、诊断时分期以及乳房X光筛查的趋势。
1999 - 2003年芝加哥黑人女性的乳腺癌死亡率比白人女性高49%，但这种差异是近期才出现的现象，且正在迅速增加。2003年黑人死亡率比白人高68%。20世纪80年代死亡率相似，只是在90年代开始出现差异，原因是白人女性死亡率大幅改善，而黑人女性没有改善。鉴于至少自1996年以来芝加哥黑人和白人自我报告的乳房X光筛查率相同，且黑人女性乳腺癌的早期发现一直在增加，黑人女性缺乏进展令人困惑。
芝加哥黑人女性乳腺癌死亡率在23年里没有改善。本研究以及文献综述支持了以下假设，即乳腺癌死亡率差异是由于乳房X光检查的可及性不同、乳房X光检查质量不同以及乳腺癌治疗的可及性不同。幸运的是，所有这三点都可通过干预加以改善，这将有助于缓解这种不可接受的差异。
