Clive O. Callender Health Sciences Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, District of Columbia, USA.
Division of Surgical Oncology, Department of Surgery, Howard University Hospital, Washington, District of Columbia, USA.
J Womens Health (Larchmt). 2022 Sep;31(9):1255-1261. doi: 10.1089/jwh.2021.0113. Epub 2022 Feb 28.
Breast cancer is the most common noncutaneous malignancy affecting women in the United States, with >245,000 cases diagnosed annually. Breast cancer mortality rates have continued to trend down in the past three decades, yet racial/ethnic disparities persist, with the worst mortality rates seen in Black women. Of note, when compared by race, this downward trend is also trailing in Black women. Survival after breast cancer is mainly driven by factors related to early detection and effective therapy. These factors can be grouped into "biological" such as age, genetic mutations, tumor characteristics; and "social" such as education, income, access to care. There have been studies attributing racial disparities solely to biological factors, and there are those attributing the disparities to social factors alone. Although the exact mechanism is unclear, a relationship between both factors as relates to racial disparities in breast cancer outcomes has been demonstrated. In this report, we review factors contributing to the increased morbidity and mortality for breast cancer in Black women and explore sociological relationships. Facing the worst poverty rates compared with other races, Black women are inevitably more likely to be uninsured, have limited access to quality education, and have fewer financial resources. The goal of this review was to elucidate the complex interplay between biological and social factors contributing to racial disparities in breast cancer outcomes. We conclude by emphasizing the need for interventions made at both local and national levels.
乳腺癌是美国女性中最常见的非皮肤恶性肿瘤，每年诊断出超过 24.5 万例。在过去的三十年中，乳腺癌死亡率持续呈下降趋势，但仍存在种族/民族差异，黑人女性的死亡率最高。值得注意的是，按种族划分，这一下降趋势在黑人女性中也有所滞后。乳腺癌的生存主要取决于早期发现和有效治疗相关的因素。这些因素可分为“生物学”因素，如年龄、基因突变、肿瘤特征；和“社会”因素，如教育、收入、获得医疗服务的机会。有研究将种族差异归因于生物学因素，也有研究将这些差异归因于社会因素。尽管确切的机制尚不清楚，但已经证明这两个因素与乳腺癌结果的种族差异之间存在关系。在本报告中，我们回顾了导致黑人女性乳腺癌发病率和死亡率增加的因素，并探讨了社会关系。与其他种族相比，黑人女性面临着最高的贫困率，她们不可避免地更有可能没有保险，接受高质量教育的机会有限，经济资源也较少。本综述的目的是阐明导致乳腺癌结果种族差异的生物学和社会因素之间的复杂相互作用。最后我们强调了需要在地方和国家层面进行干预。
