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June, 2007


Highlights in Minority Health
& Health Disparities
October, 2006

Breast Cancer Awareness Month - October, 2006
OCTOBER 2006 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
EXAMPLES OF IMPORTANT HEALTH DISPARITIES
Racial and Ethnic
  red arrow In 2002, the breast cancer incidence rate was 1.2 times higher for non-Hispanic white women (144.2 per 100,000) than for African American women (119.3 per 100,000).3  However, In 2003 the breast cancer death rate was 1.3 times higher for African American women (34.0 per 100,000) than for non-Hispanic white women (25.2 per 100,000), and 2.7 times higher for than for Asian American women (12.6).4
  red arrow From 1995-2001, the breast cancer 5-year survival rate was 1.2 times higher among white women (89.5%) as among African American women (75.9%).5
  red arrow In 2003, non-Hispanic white and non-Hispanic black women ages 40 and over were 1.1 times more likely to have a mammogram (70.5%) than Hispanic/Latina women (65.0%) and American Indian/Alaska Native women (63.1%), and 1.2 times more likely to have a mammogram than Asian American women (57.6%).6
 

Table 1: Breast Cancer Incidence and Death Rates by Race

 
  Incidence rate
per 100,000 population, 2003
7
Death rates
per 100,000
population, 2003
4
Whites 125.0 24.7
African Americans 116.0 34.0
American Indians / Alaska Natives N/A 14.0
Asian Americans and Pacific Islanders 83.7 12.6
Hispanic/Latinos 84.5 16.1
Non-Hispanic Whites N/A 25.2

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Disability
  red arrow In 2003, 65% of women with disabilities ages 40 and over had had a mammogram in the prior two years.8 This compares to 70% of all women over age 40 who had a mammogram in the 2003 (age-adjusted).6

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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%).** 9
  red arrow During 1975-1999, SEER female breast cancer incidence rates were 31% higher in lower poverty areas* (136.3 per 100,000 populations vs. 103.9), with incidence rates increasing more rapidly in lower poverty groups than in higher poverty groups.9
  red arrow The percent of women over 40 who reported receiving a mammogram in the last year rose with education level among American women.  Compared to those with some college or more (75.1%), only 58.1% of those with no high school diploma or GED had the screening test.6
  red arrow Women ages 40-64 with health insurance were 1.8 times more likely to have a mammogram in 2003 compared to those without health insurance (75.1% vs. 41.5%).6
  red arrow In 2003, breast cancer incidence was somewhat higher among those with family income of less than $20,000 per year (1.3%) and $35,000-54,999 per year (1.3%) compared to other income brackets ($20K-$34,999: 1.1%; $55K+: 1.0%).10

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Age
  red arrow In 2003, women ages 55-64 were 1.9 times more likely to die from breast cancer (56.6 per 100,000) as women ages 45-54 (30.4 per 100,000), and those ages 75-84 were 4.1 times more likely to die from breast cancer (123.7 per 100,000) as those ages 45-54.11
  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 white women 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.12
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.13

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WHAT CDC IS DOING
CDC’s Division of Cancer Prevention and Control engages in the following activities:
red arrow Monitoring: CDC provides funding and assistance to help states, tribes/tribal organizations, and territories collect data on cancer incidence and deaths, cancer risk factors, and the use of cancer screening tests. Public health professionals use the data to identify and track cancer trends, strengthen cancer prevention and control activities, and prioritize the use of resources.
red arrow Conducting Research and Evaluation: CDC conducts and supports studies designed to help the cancer community better understand the factors that increase cancer risk, and identify opportunities to prevent cancer. CDC also evaluates the feasibility and effectiveness of strategies designed to prevent and control cancer.
red arrow Building Capacity and Partnerships: CDC works with partners to translate research into public health programs, practices, and services. To ensure that innovations reach the people who most need them, CDC helps states, tribes/tribal organizations, and territories build the capacity to apply scientific advances to the development of strong cancer control programs.
red arrow Educating: CDC develops communication campaigns and materials designed to teach health professionals, policy makers, the media, and the public about cancer prevention and control.14

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PROGRAMS AND ACCOMPLISHMENTS
red arrow The National Comprehensive Cancer Control Program is a collaborative process through which a community and its partners pool resources to promote cancer prevention, improve cancer detection, increase access to health and social services, and reduce the burden of cancer. These efforts will contribute to reducing cancer risk, detecting cancers earlier, improving treatments, and enhancing survivorship and quality of life for cancer patients.15
red arrow CDC National Breast and Cervical Cancer Early Detection Program (NBCCEDP)
provides access to critical breast and cervical cancer screening services for underserved women in the United States, the District of Columbia, 4 U.S. territories, and 13 American Indian/Alaska Native organizations (16).  Since 1991, the NBCCEDP has served more than 2.5 million women, provided more than 5.8 million screening examinations, and diagnosed more than 22,000 breast cancers.
17
red arrow CDC National Program of Cancer Registries (NPCR)
Data collected by state cancer registries enable public health professionals to understand and address the cancer burden more effectively. CDC provides support for states to maintain registries that provide high-quality data.
18
red arrow 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.19
red arrow Other breast cancer-related projects include
     Use of Mass Media by African American Women;
    Breast and Cervical Cancer Screening in Never and Rarely Screened Women;
    Data Linkage with the Indian Health Service;
    Racial Differences in Risk Factors for Breast Cancer; and
    Study Highlights Methods and Messages for Reaching Diverse Populations.20

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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.

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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)

    The National Breast and Cervical Cancer Early Detection Program: 1991–2002 National Report
    United States Cancer Statistics, 2002 Incidence and Mortality
    Health Disparities: Minority Cancer Awareness
    National Cancer Data
 

National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

    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 Risk Assessment Tool
  Other Organizations
 

National Breast Cancer Awareness Month (NBCAM)

  American Cancer Society (ACS)
    Breast Cancer Facts and Figures 2005-2006

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SOURCES
1. National Institutes of Health (NIH), “A Snapshot of Breast Cancer,”  2005, p. 1
2. NIH, National Cancer Institute (NCI), “Probability of Breast Cancer in American Women,” 2005, p. 1
3. CDC, National Center for Health Statistics (NCHS), Health United States, 2005, table 53
4. CDC, NCHS, Health United States, 2005, table 29
5. CDC, NCHS, Health United States, 2005, table 54
6. CDC, NCHS, Health United States, 2005, table 86
7. National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results (SEER) Program, Public-Use, Nov 2005
8. CDC, CDC Wonder, Data2010
9. NIH, NCI, United States Cancer Statistics: 2002 Incidence and Mortality, p. 6
10. CDC, NCHS, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2003 table 6
11. CDC, NCHS, Health United States, 2004, table 40
12. NIH, NCI, “NCI Health Information Tip Sheet for Writers: Cancer Health Disparities,” 2005
13. CDC, Office of Minority Health (OMH), “Eliminate Disparities
in Cancer Screening & Management,”
2005
14. CDC, About CDC Cancer Prevention and Control,  2006
15. CDC, NCCDPHP, Cancer Prevention and Control, 2005 
16. CDC, NCCDPHP, “Health Disparities: Minority Cancer Awareness,” 2005
17. CDC, NCCDPHP, The National Breast and Cervical Cancer Early Detection Program,  2006 Fact Sheet
18. CDC, National Program of Cancer Registries
19. CDC, Racial and Ethnic Approaches to Community Health (REACH) 2010, 2005
20. CDC, Health Disparities in Cancer, Science and Research, 2006

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