The last several years have seen growing awareness of how structural inequities can impact individual health outcomes. Two powerful new JAMA Network Open studies reinforced what we know about structural inequity, particularly as it relates to breast cancer.
In the first study on April 19 addressing racial differences in breast cancer mortality, researchers looked at over 415k women from 2011 to 2020, finding:
- Black women between 40 and 49 years old had the highest breast cancer mortality rates per 100,000 person years, at 27 deaths. This compares to 15 deaths for White women, and 11 deaths for other ethnicities.
- If breast screening were tailored based on risk at age 50, Black women should start screening eight years earlier than White women, at 42 years of age versus 51.
- Biennial mammography screening of Black women starting at age 40 would reduce the gap in breast cancer mortality compared to White women by 57%.
In the second study on April 21, researchers drilled even deeper into structural inequity, focusing on breast cancer outcomes in disadvantaged neighborhoods in a large, racially diverse region in southern Florida that’s home to 6.2M people.
In all, their study covered 5,027 women with breast cancer, and they categorized neighborhoods into three levels based on socioeconomic status. Findings included:
- Patients living in the second most disadvantaged neighborhoods were 36% more likely to die of breast cancer (HR=1.36).
- Women living in the most disadvantaged neighborhoods were 77% more likely to die (HR=1.77).
The researchers pointed out that their results went beyond merely linking race to health outcomes, as they adjusted for race and ethnicity “as a proxy for structural racism.” They suggested that there could be “unaccounted,” biologic mechanisms related to neighborhood disadvantage that lead to shorter breast cancer survival. The findings echo other studies that have linked patient location to access to imaging.
The Takeaway
Over the past several decades, breast cancer’s dropping mortality rate has been a health policy success story. But the new studies indicate that progress has been uneven, and more attention is needed to ensure that the benefits of improved breast cancer diagnosis and treatment are distributed more equitably.
