Racial disparity in breast cancer mortality: An examination of state at diagnosis, estrogen receptor status and treatment experiences

Background. African American women have a lower incidence of breast cancer than White women, but a higher mortality rate from breast cancer than White women. Objective. The purpose of this dissertation is to fill significant gaps in the understanding of racial disparities in breast cancer stage at diagnosis and survival. This study attempts to better define the racial disparity by examining age-specific trends in stage at diagnosis over time, age-specific trends in estrogen receptor status over time, and to explore how the treatment experiences of African American women might identify some reasons behind worse outcomes even within stage of disease categories. Design. This study is designed as a mixed-method study that includes both quantitative data analysis and primary qualitative data collection/analysis. The three phases of the research are: (1) an analysis of age-specific trends in African American/White differences in breast cancer stage at diagnosis using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program data; (2) an analysis of age-specific trends in African American/White differences in breast cancer estrogen receptor status using the SEER Program data; and (3) semi-structured interviews with 40 African American breast cancer patients to discuss treatment decisions and experiences. Results. For every age group, African American women were less likely to present with early stage breast cancer. For every age group, African American women were less likely to present with ER positive breast cancer. The trends for African American and White women overtime were very similar, with the disparity gap hardly changing. In qualitative interviews, African American women reported challenges and fears regarding treatment side effects and family management. Respondents were generally satisfied with the treatment decision process and the treatment outcomes. One important factor in this satisfaction was patient-provider interactions. Most participants completed their treatment; however, some respondents chose to discontinue hormonal therapy, which may explain some of the survival disparity. Finally, respondents felt fear, silence and ignorance in the African American community was a significant factor in this health disparity, suggesting more efforts need to be made to disseminate culturally-sensitive information on breast cancer, breast cancer care, and breast cancer outcomes.