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Press Briefing Transcript

Vital Signs: Disparities in breast cancer continue among U.S. women

Thursday, November 14, 2012 at 12 p.m. ET

OPERATOR: Welcome.  And thank you for standing by.  At this time, all participants are in a listen-only mode until the question and answer session of today's conference.  At that time, you may press star 1 to ask a question.  I would like to inform all participants that today's conference is being recorded.  If you have any objections, you may disconnect at this time.  I would now like to turn the conference over to Karen Hunter.  You may begin. 

KAREN HUNTER:  Thank you and good afternoon.  Welcome to today's MMWR vital signs telebriefing highlighting breast cancer disparities.  Our speakers today will be Dr. Ileana Arias and doctor Arias is a Ph.D. And let me spell her name, its I-L-E-A-N-A, last name, A-R-I-A-S.  We'll also be hearing from Dr.   Marcus Plescia, he is an MD, and his name is M-A-R-C-U-S, last name is spelled P-L-E-S-C-I-A.  He is the director of CDC's Division of Cancer Control and Prevention.  Dr.  Arias is the Principle Deputy Director of CDC.  And we will begin with Dr.  Arias. 

ILEANA ARIAS:  Thanks Karen. Good afternoon and thank you for joining today to discuss a very serious problem for all women --- breast cancer --- with a particular focus on a troubling disparity in the U. S. – Breast cancer in black women. Today, CDC released its monthly Vital Signs report, a special Morbidity and Mortality Weekly Report highlighting critical public health issues that face our country. This month’s Vital Signs report is on breast cancer death rates among black women. Black women are 40 percent more likely to die from breast cancer compared to white women.  Breast cancer death rates among women in the U.S. generally have actually declined in the past two decades.  But, black women are not experiencing that same drop in death rates. Black women are diagnosed with breast cancer at lower rates, then white women; yet they have higher death rates compared to any other racial or ethnic group.  During 2005 through 2009, for every 100 breast cancers diagnosed - black women had nine more deaths compared to white women who were diagnosed during that same time period.

There are a number of factors that we think contribute to this health disparity, but there are two that are of particular importance. First, is that there are unacceptable gaps in the provision of timely, adequate, and appropriate healthcare, and the second is the difficulty that women have in navigating our complex health care system. As a public health leader - and as a woman - I find these disparities in breast cancer deaths unacceptable, but fortunately for us we also know that they are avoidable.  Therefore, today’s report serves as a national call to action to make breast cancer death rates among black women a national priority among all entities. This includes the Federal government, state and local health departments, health care systems, and individual health care workers.

Addressing the problem is complex; fortunately we are now closer to a solution with the important passage of the Affordable Care Act. The Affordable Care Act is going to dramatically increase access to health care, especially for health screenings, such as mammograms, with co-pays in many health plans, and beginning in 2014, the law will expand access to health insurance coverage for 30 million previously un-insured Americans. This is critically significant since research has shown that the lack of access to health care has been a major reason why women do not get cancer screening tests. The Affordable Care Act also has multiple provisions that improve the quality of care including: significant investments in the implementation and use of electronic health records and case management so that essentially women get timely follow up and care they need after a mammogram. To date over $80 million have already been invested to help networks of health centers adopt electronic health records and other health information technology. Additionally, helpful are investments in preventive interventions from the Prevention and Public Health Funds. And Health Care Innovation Challenge grants that will test promising new payment and care delivery models to increase accessibility, availability, and quality of healthcare.

Today’s Vital Signs report highlights critical issues in the quality of care for black women that have a clear impact on their health. To talk more about the “Vital Signs” report and what we can do and clearly must do to address these disparities, I am pleased to now turn it over to Dr. Plescia.

MARCUS PLESCIA: Thank you, Dr.  Arias.  I now will like to provide a little bit more details about the report we just released. Breast cancer is the second leading cause of cancer deaths among women in the United States; this report highlights the outcomes for black women with breast cancer that are poor.  This “fatal” disparity must end. Today’s report includes cancer registry data from 2005 through 2009 from the Centers for Disease Control and the National Cancer Institute’s combined cancer registry programs, along with death certificates from CDC’s National Vital Statistics System.

I like to share a few major findings from the report that show black women do not receive the same quality of breast cancer screening, timely follow up for abnormal tests, or quality of treatment.  Although black women report getting mammograms at the same rates as white women, 45% of black women are diagnosed with more advanced breast cancer (breast cancer that has spread beyond the breast) that’s compared with only 35% of white women. Timeliness of care is a particular challenge. For example 20% of black women experience follow-up times of more than 60 days after an abnormal mammogram compared with only 12% of white women. Only 69% of black women start treatment within 30 days compared with 83% of white women, and fewer black women receive surgery, radiation, and hormone treatments they need compared to white women. There are many factors involved with these disparities and further research is needed to help us understand the causes which include the biology of breast cancer in black women and the role of Socioeconomic Factors. The federal government is supporting this area of research. However, recent study showed that death rates could be reduced by close to 20 percent if the same treatment was received by both groups of women.

So solutions to address these disparities are within our reach, but all parties have to be involved to make equal treatment a priority. There is a shared responsibility for all of us, government, local health agencies, health care systems, health care providers and patients. We know what works to make an impact in closing the gap in breast cancer death rates. At the Centers for Disease Control, we’ve breast cancer disparities a priority and have more than 20 years of providing high quality services to uninsured woman.  The National Breast and Cervical Cancer early detection program, administered by CDC requires health care providers to track and report on follow-up and treatment times for all patients and establish quality bench marks. We also have recently established the use of evidence base approaches such as patient navigators and case managers serving in underserved communities. These are emerging approaches, which have a proven track record of assisting women in getting the care they need promptly.

Finally, to further address this issue from all approaches women need the knowledge skill and support to participate in our complex health care system. Women can learn more about breast cancer and the severity of the disease from reputable sources like the Centers for Disease Control and the National Cancer Institutes. They can talk with their doctor about their risk for breast cancer, when to get a mammogram and perhaps most importantly when to expect their results and what an abnormal test means.  

In closing, I would like to emphasize that the full benefit of breast cancer screening can only be achieved when we ensure that EVERY woman receives timely follow up, and high-quality treatment.Thank you.  Now, I will turn back over to Dr. Arias.
ILEANA ARIAS: Thanks. I would like to now just close with our remarks with just three key points from today's report. Despite a decline in breast cancer deaths, black women continue to have unacceptably high death rates. They continue to have the highest death rates from breast cancer among all racial and ethnic groups. Second, the federal government, state and local health agencies, the health care system, and health care providers must ensure that black women, like all women, have access to timely follow-up after abnormal breast cancer exams and high quality treatment if diagnosed with breast cancer. And lastly, but most importantly, bottom line is that many black women's lives could be saved each year if they receive screening and quality treatment.  We have achieved significant success in the fight against breast cancer in this country, as I mentioned earlier, but everyone must continue to work together in this terrible disease for all women and especially for those most in need so that daughters, mother, wives, and sisters have the best chance of surviving breast cancer. 

KAREN HUNTER: Thank you, Dr. Arias and Dr. Plescia.  And now we would like to answer some questions. 

OPERATOR: If you would like to ask a question, press star 1 to record your name clearly.  To withdraw your request, you may press star 2.  Just one moment for our first question.  And our first question comes from Nick Bakalar of the The New York Times. Your line is open. 

NICK BAKALAR: Hi. You know, I'm trying to figure out what's more important to you, screening or treatment.  If you had a choice to concentrate on one or the other, which would be more important in close this gap? 

MARCUS PLESCIA: Well, we think that screening is very important, and that's where much of our emphasis at CDC has, has been thus far.  Although I think what the report shows is that these issues of follow-up and screening are also very, very important so if we're going to have strong national screening programs we have to make sure that the follow-up and treatment is there for everyone who has an abnormal result. 

 ILEANA ARIAS: And just to follow up on that, I think we all agree that screening is the gatekeeper and without appropriate screening we cannot intervene in an effect way.  However, we also then know and are trying to emphasize the importance of making sure that the continuum of care is being attended to and represented in order to make sure that we are successful in bringing down those rates. 

KAREN HUNTER: Thank you.  Next question? 

OPERATOR: I show no other questions at this time. 

KAREN HUNTER:  All right.  Well, this concludes today's MMWR Vital Signs telebriefing.  If you have follow-up questions or need additional information please contact CDC's main press office at 404-639-3286 or you can e-mail us at media@CDC.gov.  And thanks very much for joining us today. 

OPERATOR: That concludes today's conference.  Thank you for your participation.  You may disconnect at this time.  

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