Women of color have not enjoyed the same reduction in breast cancer mortality experienced by white women over the past several decades, and breast cancer mortality rates tend to be higher in areas where women are underinsured and lack access to care, according to separate presentations by Dr. Phil Evans from the University of Texas Southwestern Medical Center and Dr. Murray Rebner from Oakland University's William Beaumont School of Medicine.
In his talk, Evans discussed the challenges uninsured and underinsured women face in choosing affordable healthcare, citing the high number of uninsured women in Dallas County, TX, who visit Parkland Memorial Hospital for treatment.
Over 400 women are diagnosed with breast cancer each year at the hospital, with more than two-thirds being uninsured or underinsured and 75% being Hispanic or African American.
"This group of patients has competing social and economic demands, including limited financial resources, social distress, housing and food insecurity, and sometimes intimate partner violence," Evans said.
The highest breast cancer mortality rate in Dallas County is localized to areas where women have high uninsured rates and less access to healthcare (22 to 27 per 100,000). The African American population has the highest breast cancer mortality rate in Dallas County, at 31.8 cases per 100,000, according to 2016 data presented by Evans.
Evans called for improved access to care through U.S. states fully adopting expanded Medicaid coverage as stated by the Affordable Care Act of 2010. Evans cited a 2020 study from JAMA Surgery that found states with expanded Medicaid coverage had a 2.5% decrease in advanced-stage breast cancer in all races.
In his presentation, Rebner broke down some specifics in the incidence of breast cancer in African American women compared with white women.
Although the death rate for breast cancer since 1990 has decreased by 40% for all women, it has only decreased by 26% for African American women. Studies have also indicated breast cancer occurs more frequently in Black women younger than 50 than in white women of the same age group.
BRCA mutations also occur more frequently in African American women, and the aggressive triple-negative subtype of breast cancer occurs more frequently in Black women than in white women, research suggests.
Both Evans and Rebner called for more education for patients.
Evans cited a study published in 2015 in Cancer Epidemiology, Biomarkers & Prevention that found women presenting with symptomatic breast cancer were more likely to have lower levels of education and income, have unfavorable subtypes and present at a higher stage, and have no health insurance.
"We need to improve education, particularly about the benefits and cost of screening, and know about the opportunities about where people can get screened with a free mammogram," Evans said. "We also need to promote the quality of facilities screening for the uninsured and increase compliance with guidelines."
Rebner, meanwhile, cited a 2016 study published in Cancer that found African American women were less likely to adhere to screening guideline recommendations, such as for MRI, from national organizations either because they didn't realize they were at high risk or because their healthcare provider didn't recommend it.
"Screening needs to be affordable. There should be no copays or deductions," he said. "It's also critical we educate patients and providers. The No. 1 reason why a patient gets a screening mammogram is because her provider recommended it."
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