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Highlights in Minority Health
October, 2005
Breast Cancer Awareness Month October 2003
 

OCTOBER IS BREAST CANCER AWARENESS MONTH
   
In the United States, breast cancer is the most common non-skin cancer and the second leading cause of cancer-related deaths in women 1.  The National Cancer Institute estimates that, based on current rates, 13.2% of women born today will be diagnosed with breast cancer at some time in their lives 2.  Each year, a small number of men are also diagnosed with or die from breast cancer 1.
 

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EXAMPLES OF IMPORTANT HEALTH DISPARITIES
 
Racial and Ethnic
  red arrow In 2001, the breast cancer incidence rate was 1.3 times higher for non-Hispanic whites (148.3 per 100,000) than for African Americans (111.9 per 100,000) 3.  However, In 2002 the breast cancer death rate was 1.3 times higher for African Americans (34.0 per 100,000) than for Non-Hispanic whites (25.6 per 100,000) 4.
 

Table 1: Breast cancer incidence and death rates by race

 
  Incidence rate
per 100,000 population, 2001
Death rates
per 100,000
population, 2002
Whites 139.0 25.0
African Americans 111.9 34.0
American Indians / Alaska Natives 49.5 13.8
Asian Americans and Pacific Islanders 97.8 12.8
Hispanic/Latinos 85.4 15.5
Non-Hispanic Whites 148.3 25.6
 

Source:  NCHS, Health, United States, 2004, tables 29 and 53.

     
  red arrow From 1992-2000, the breast cancer 5-year survival rate was 1.2 times higher among white women (88.3%) as among African American women (74.1%) 5.
  red arrow According to the American Cancer Society, in 2000 non-Hispanic white women ages 40 and over were 1.1 times more likely to report receiving a mammogram in the prior two years (72.1%) compared to non-Hispanic African Americans (68.2%), 1.2 times more likely than Hispanic/Latinas (62.6%), 1.4 times more likely than American Indians and Alaska Natives (52.4%), and 1.3 times more likely than Asian Americans (57.0%) 6.
 
Immigration
  red arrow Women who were born in the U.S. were 1.7 times more likely to have a mammogram in the prior two years compared with those who lived in the U.S. for less than 10 years (71.6% vs. 41.4%) 6.
 
Disability
  red arrow In 1994, 53.3% of women 40 through 49 years of age with at least one functional limitation and 60.6% of women without any limitation had received mammography screening during the prior two years 7.
    grey square The gap between women with and without functional limitations was widest among women in that age group, but the trend persisted across all examined age categories (40 years of age or younger, 40 through 49, 50 through 64, and 65 years of age or over), suggesting a need for screening interventions for women with disabilities aged 40 years of age or older.  Women younger than 40 years of age should discuss screening with their provider 7.
 
Income and Education
  red arrow During 1997-1999, U.S. breast cancer mortality was 41% higher for Hispanic/Latina women in high poverty areas* (19.0%) than those in low poverty areas (13.5%)** 8.
  red arrow During 1975-1999, SEER female breast cancer incidence rates were higher in lower poverty areas*, with incidence rates increasing more rapidly in lower poverty groups than in higher poverty groups 8.
  red arrow The percent of women who reported receiving a mammogram in the last year rose with education level among American women.  Compared to those with 16 or more years of education (80.1%), only 56.8% of those with 11 or fewer years of education had the screening test 6.
  red arrow Women with health insurance were 1.9 times more likely to have a mammogram in the last 2 years compared to those without health insurance (73.6% vs. 39.5%) 6
  red arrow In 2003, breast cancer prevalence was somewhat higher among those with family income of less than $20,000 per year (1.3%) and $35,000-54,999 per year (7.3%) compared to other income brackets ($20K-$34,999: 1.1%; $55K+: 1.0%) 10.
 
Age
  red arrow In 2002, women ages 55-64 were 1.8 times more likely to die from breast cancer (56.2 per 100,000) as women ages 45-54 (31.4 per 100,000), and those ages 75-84 were 4.0 times more likely to die from breast cancer (125.9 per 100,000) as those ages 45-54 9
  red arrow In 2003, the percent of Americans ages 65-74 diagnosed with breast cancer (4.1) was 3.2 times higher than those ages 45-64 years (1.3) 10.

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PROMISING INTERVENTION STRATEGIES
 
Racial and ethnic minorities tend to receive lower-quality health care than whites even when insurance status, income, age and severity of conditions are comparable. Many of the differences in cancer incidence and mortality rates among racial and ethnic groups may be due to factors associated with social class rather than ethnicity. Socioeconomic status, in particular, appears to play a major role in differences in cancer incidence and mortality rates, risk factors and screening prevalence among racial and ethnic minorities 11.
 
Minority groups’ access to cancer care and clinical trials has been expanded to ensure that people in these communities are provided the same quality, access, and state-of-the-art technology that patients in major care centers receive 12.

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PROGRAMS AND ACCOMPLISHMENTS
WHAT CDC IS DOING:
  red arrow The National Comprehensive Cancer Control Program integrates and coordinates efforts to reduce cancer’s effects by monitoring cancer cases, developing policies to promote cancer prevention and control, developing cancer education programs, establishing intervention programs that target populations at high risk, supporting screening and education services, and evaluating programs 13.
 
blue sphere
CDC National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
NBCCEDP provides breast and cervical cancer screening, diagnosis, and treatment to low income, medically underserved, and un-insured women (emphasizing recruitment of minority women) through states, tribes and territories 14.
 
 
blue sphere
CDC National Program of Cancer Registries (NPCR)
NPCR provides funding and technical assistance to states, territories, and the District of Columbia for enhancing established cancer registries or developing and implementing new cancer registries. NPCR is essential to state cancer planning and the identification of populations that experience cancer health disparities 14.
 
blue sphere
The Mautner Project for Lesbians with Cancer
This project has been funded by the CDC for five years. The Mautner Project provides direct services to lesbians with cancer, their partners, and caregivers. This project aids in educating and informing both the lesbian community as well as the health care community of the special concerns in cancer. The Mautner Project also provides advocates for lesbian health issues in national and local arenas 14.
  blue sphere REACH 2010 is a federal initiative which includes the goal of eliminating racial and ethnic disparities in health by the year 2010. This goal is one of two goals that parallels the focus of Healthy People 2010, which describes the nation's health objectives for the decade. REACH 2010 is part of the national initiative to eliminate disparities in health status experienced by racial and ethnic minority populations in six priority areas, including breast cancer 15.

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FOR MORE INFORMATION
   
Centers for Disease Control and Prevention (CDC)
 

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)

 

Cancer Prevention and Control (CPC)

    Health Disparities: Minority Cancer Awareness
    National Cancer Data
 

National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

    Breast Cancer & Mammography Information
    Breast and Cervical Cancer Screening Practices Among Hispanic and Non-Hispanic Women Residing Near the United States–Mexico Border
 

National Center for Health Statistics (NCHS)

    Cancer Fastats
 

Racial and Ethnic Approaches to Community Health (REACH) 2010

 
OTHER FEDERAL GOVERNMENT
 

National Cancer Institute (NCI) Breast Cancer Home Page

    Breast Cancer: U.S. Racial/Ethnic Cancer Patterns
    Breast Cancer Risk Assessment Tool
    Understanding Breast Cancer Treatment
 

MedLinePlus: Breast Cancer

 

ORGANIZATIONS

  American Cancer Society (ACS) All about Breast Cancer
  National Breast Cancer Awareness Month (NBCAM)
    National Mammography Day
  Susan G. Komen Breast Cancer Foundation
  National Alliance of Breast Cancer Organizations (NABCO)
  National Breast Cancer Coalition (NBCC)
  Breast Cancer Research Foundation
  National Breast Cancer Foundation
  breastcancer.org

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NOTES

* Defined as 20% or higher of county population below the poverty level in 1990.
** Defined as <10% of county population below the poverty level in 1990.

 

SOURCES

1. National Institutes of Health (NIH), “A Snapshot of Breast Cancer,  2005” http://prg.nci.nih.gov/snapshots/Breast-Snapshot.pdf
2. NIH, National Cancer Institute (NCI), “Probability of Breast Cancer in American Women,” 2005 http://cis.nci.nih.gov/fact/5_6.htm
3. CDC, National Center for Health Statistics (NCHS), Health United States, 2004, table 53 http://www.cdc.gov/nchs/data/hus/hus04trend.pdf
4. CDC, NCHS, Health United States, 2004, table 29 http://www.cdc.gov/nchs/data/hus/hus04trend.pdf
5. CDC, NCHS, Health United States, 2004, table 54 http://www.cdc.gov/nchs/data/hus/hus04trend.pdf
6. American Cancer Society (ACS), Cancer Prevention and Early Detection Facts and Figures, 2005 http://www.cancer.org/downloads/STT/CPED2005v5PWSecured.pdf
7. CDC, National Center for Birth Defects and Developmental Disabilities (NCBDDD), “How does the health status of people with disabilities compare with the health status of people without disabilities?” 2005 http://www.cdc.gov/ncbddd/dh/disparitiesinhealth.htm
8. NIH, NCI, Incidence and Mortality http://seer.cancer.gov/publications/ses/incidence.pdf
9. CDC, NCHS, Health United States, 2004, table 40 http://www.cdc.gov/nchs/data/hus/hus04trend.pdf
10. CDC, NCHS, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2003 p. 34-35 http://www.cdc.gov/nchs/data/series/sr_10/sr10_225.pdf
11. NIH, NCI, “NCI Health Information Tip Sheet for Writers: Cancer Health Disparities,” 2005 http://www.cancer.gov/newscenter/tip-sheet-cancer-health-disparities
12. CDC, Office of Minority Health (OMH), “Eliminate Disparities
in Cancer Screening & Management,” 2005 http://www.cdc.gov/omh/AMH/factsheets/cancer.htm
13. CDC, NCCDPHP, Cancer Prevention and Control, 2005 http://www.cdc.gov/nccdphp/bb_cancer/index.htm
14. CDC, NCCDPHP, “Health Disparities: Minority Cancer Awareness,” 2005 http://www.cdc.gov/cancer/minorityawareness/index.htm#pia
15. CDC, Racial and Ethnic Approaches to Community Health (REACH) 2010, 2005 http://www.cdc.gov/reach2010/goals.htm

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