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January 21, 2021

Deconstructing Racial and Ethnic Disparities in Breast Cancer

Author Affiliations
  • 1Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • 2Johns Hopkins School of Medicine and The Bloomberg School of Public Health, Baltimore, Maryland
JAMA Oncol. 2021;7(3):355-356. doi:10.1001/jamaoncol.2020.7113

The US has become more racially and ethnically diverse over the past century. It is projected that minority populations, including Black race or Hispanic ethnicity, will exceed 50% of the US population by the year 2044.1 Although cancer mortality has substantially declined in the US, deep racial and ethnic divides remain in cancer outcomes. Blacks have an 11% higher age-adjusted death rate for all cancers compared with Whites, whereas Hispanics have a 31% lower rate; the divide is even more pronounced in breast cancer, where Blacks have a 36% higher age-adjusted breast cancer death rate than Whites, and Hispanics have a 31% lower rate.2 For those diagnosed with cancer, however, both racial and ethnic minority groups have worse outcomes compared with non-Hispanic Whites. For example the adjusted relative risk of death for all cancers combined is 33% higher for non-Hispanic Blacks and 16% higher in Hispanics than in non-Hispanic Whites. For breast cancer, compared with non-Hispanic Whites, the adjusted relative risk of death is 71% higher for non-Hispanic Blacks and 14% higher in Hispanics.3 Evidence indicates that these disparities in the overall population for Blacks, and in those diagnosed with cancer for both Blacks and Hispanics, are largely driven by disparities in social determinants of health, including access to medical care, quality of care, and greater comorbidity burden occurring as a consequence of socioeconomic inequalities.4 For prostate cancer, these disparities are erased within stage when equal treatment is administered in the context of an equal-access health care system, or in clinical trials.5 On the other hand, several reports have indicated that racial disparities persist in women with breast cancer participating in National Cancer Institute (NCI)–sponsored clinical trials and receiving equal treatment.6-9 Any research shedding light on factors contributing to racial disparities is welcome, especially in breast cancer, the most commonly diagnosed cancer and second leading cause of cancer death in women.3

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