Breast cancer is still the most diagnosed cancer and the second leading cause of cancer deaths among women in the United States after lung cancer [2]. It was reported that in 2013, an estimated 3,053,450 women were living with breast cancer [1]. The estimated new cases of breast cancer in 2016 amounted to 246,660, making up 14.6% of all new cancer diagnoses in the US, and 40,450 women were estimated to succumb to the disease. In this short review of current trends in breast cancer incidence, mortality, survival, and screening, we will take a quick look at disparities among populations by race, age, disability, socioeconomics, culture, and sexual orientation; and then discuss them in terms of cancer prevention by addressing the known causes of these disparities: biological factors, lifestyle choices, access to healthcare and socioeconomic factors [4].
According to data from United States Cancer Statistics (USCS), breast cancer mortality declined from 2010 to 2014 in the US. Unfortunately, progress has been slower in some populations than it has in others [3]. Certain populations continue to be disproportionately burdened by higher incidence and mortality rates of breast cancer and lower survival rates after treatment of the disease. There are many complex factors that contribute to breast cancer disparities and most are integrated with each other. For example, in addressing racial disparities, Richardson et al 2016, uses age to further explain the health trends in his interpretation of the USCS statistics. Traditionally, black women have had lower incidence of breast cancer than white women, but incidence rates for the two groups have recently converged. Population based data points to increasing rates among black women as the cause; aged 60-79 years in particular. Mortality rates continue to be higher among black women in comparison to white women, while the breast cancer death rates are decreasing faster for white women [2]. However, overall breast cancer death rates have gone down at the same rate among racial groups for women under 50 years [3].
While white and black women have about the same incidence rates of breast cancer in the US, Asian, Native American, and Hispanic women have comparatively lower rates. But there can be a lot of variation even among racial and ethnic subgroups [4]. For example, the breast cancer incidence rates among Filipina women is much higher than in other Asian groups, some Hawaiian women have incidence rates higher than white women and US born Asian women have higher rates than other Asian born women [6-8]. Other disparities like those of disability where women are disadvantaged in being able to go to screenings and keep up with treatment [11], those of geography where women living in rural areas have less access to screenings [12], and those of language and cultural barriers to physician recommendations have significant incidence and mortality rate effects among these populations. Breast cancer incidence is higher among women with higher socioeconomic status which may be due to higher screenings, reproductive lifestyle choices, and more alcohol consumption [9,10], but the preponderance of literature on disparities is focused on race and more specifically black and white comparison statistics and black women are 41% more likely to die as a result of breast cancer than white women in the US [13,1].
In an effort to address these disparities, a look at the known causes can be useful because it is those same causal roads that may have the solution to closing the gaps. Biological causes of disparity, such as molecular tumor characterization, gene susceptibility, and the prevalence of triple negative type of breast cancer, may be the least controllable of the known causes, but having a biological understanding of tumor aggression can guide our recommendations in treatment and prevention. The first study (Keenan et al 2015) to methodically characterize the racial pattern of genomic and gene expression traits in primary breast tumors and assess the relationship of the racial consistencies with tumor occurrence found that in addition to having a higher prevalence of type negative breast cancer than white women, black women had greater intra-tumor genetic heterogeneity, PAM50 basal tumors, TNBC basal like 1 and mesenchymal stem-like tumors, and TP53 mutations, all of which suggest more aggressive tumor biology [13]. This elucidation of racial differences in tumor molecular analysis can help us in cancer prevention; we can exploit these differences as research moves towards formulating more precise tools for personalized medicine. Large scale federal initiatives have provided the opportunity to address racial disparities in breast cancer subtypes and molecular pathology [3]. The Precision Medicine Initiative, supported by the NIH, bolsters research that expands the development of individualized care focused on understanding how the molecular characteristics of cancers lead to phenotypic characteristics [3].
Non-biological causes of breast cancer disparity, such as access to healthcare, socioeconomic factors, and lifestyle choices, are more controllable than biological factors. Changing sedentary and eating habits, avoiding things known to cause cancer, getting regular screenings, and taking medicine to treat a precancerous condition once it has been identified are controllable cancer prevention habits that would close the disparity gaps. However, social inequalities, discrimination, and mistrust of the medical establishment prove to be impediments to getting, trusting, and heeding the agreed upon medical advice to prevent breast cancer. The solution can be to exploit the tribal tendencies of humans using cognitive-behavioral therapy-based group intervention programs conducted by public health professional that the disparate women can relate to [14]. These programs have been shown to be effective in reducing BMI and stopping habits that are counterproductive to health. Increasing trends in obesity prevalence among black women coincide with increasing incidence of breast cancer [3]. Handing out pamphlets and instructions may not be the best way to improve cancer disparities among populations; instead these group interventions may be the key to addressing survivorship disparities among the populations. Studies show that the 5-year-relative survival rate is lower for blacks when compared to non-blacks in the US [1]. Not being married or living alone has been associated with poorer general prognosis of cancer. And some researchers postulate that the reason that survivorship is lower is because there isn’t enough support after treatment [5].
Therefore, follow-up programs, based on group intervention and instituted by medical professionals, should also be considered a cancer prevention tool that will address the survivorship disparities due to treatment adherence of certain populations [5]. Many of the same factors that determine whether a woman gets screened, how, when, and where she gets treatment, also contribute to the disparities we see in breast cancer survival [1]. Group intervention led by public health professionals can act as concerted efforts to get more women to participate in early detection programs and build the trust needed in treatment and aftercare. The known causes of breast cancer incidence, mortality, and survival disparities among populations differentiated by societal groupings can be addressed using those same groupings using interventions led by trusted related healthcare professionals your essay in here…