Gerend Mary A, Pai Manacy
Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300, USA.
Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):2913-23. doi: 10.1158/1055-9965.EPI-07-0633.
Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States.
尽管近期乳腺癌死亡率有所下降，但非裔美国女性死于乳腺癌的比率仍高于白人女性。除了乳腺癌在非裔美国女性中往往比在白人女性中更具生物学侵袭性这一事实外，乳腺癌死亡率的这种差异还反映了对非裔美国女性影响尤为严重的社会障碍。这些障碍阻碍了癌症预防和控制工作，并改变了疾病的生物学表现。本综述着重阐述可能导致乳腺癌死亡率存在黑白差异的社会、经济和文化因素。本综述以健康差异的社会决定因素模型为指导，该模型将与贫困、文化和社会不公正相关的障碍确定为健康差异的主要原因。这些障碍与遗传、生物学和环境因素共同作用，在从筛查和早期发现到治疗及生存的整个乳腺癌过程中，可能导致非裔美国女性和白人女性出现不同的结果。与贫困相关的障碍包括缺乏初级保健医生、医疗保险不足以及获得医疗保健的机会不佳。与文化相关的障碍包括认为自身不易患病、民间信仰以及对医疗保健系统普遍不信任。与社会不公正相关的障碍包括种族定性和歧视。其中许多障碍有可能得到改善。因此，除了生物医学的进步之外，未来为减少乳腺癌死亡率差异所做的努力应解决那些使美国非裔美国女性和白人女性之间差异长期存在的社会障碍。
