African American women diagnosed with breast cancer generally have a worse prognosis compared to women of other races diagnosed with breast cancer. Doctors wanted to know if the difference could be due to:
- differences in access to medical care
- differences in the quality and consistency of medical care received
by African Americans. Both access to care and quality and consistency of care can be affected by whether or not a person has adequate health insurance.
A study looked at 574 African American and non-Hispanic white women, 84% of whom had inadequate or no health insurance. The African American women in the study were:
- 64% more likely to die from breast cancer compared to white women
- 69.2% of African American women were alive 7 years after diagnosis
- 75.4% of white women were alive 7 years after diagnosis
The results suggest that having no or inadequate health insurance makes a bigger difference in breast cancer prognosis for African American women compared to white women.
Besides having no or inadequate insurance, most of the women in the study were poor. All of them received breast cancer treatment at a public hospital that cares for people whether or not they have insurance. Researchers call these hospitals "public safety net" hospitals. So the researchers believed that the quality and consistency of the women's care was the same regardless of race, economic status, or type of health insurance.
Genetic factors affect the aggressiveness of breast cancer and aggressiveness affects prognosis. Genetic factors are why breast cancers diagnosed in African American women tend to be more aggressive than breast cancers diagnosed in white women and have a worse prognosis. In this study, the researchers used a complicated mathematical model to account for the genetic differences between breast cancers in African American women and breast cancers in white women. Accounting for the genetic differences showed that breast cancer prognosis was similar among white women and African American women.
Prognosis also is affected by a breast cancer's stage at diagnosis. Regular breast cancer screening helps make sure that any cancer is diagnosed at an early, more treatable stage. Lack of breast cancer screening can mean a delay in breast cancer diagnosis and a worse prognosis. This study found equally poor breast cancer screening among white and African American women. Still, the breast cancers diagnosed in the African American women tended to be more advanced at diagnosis compared to cancers diagnosed in white women.
The results suggest that having inadequate or no health insurance may affect breast cancer prognosis more in African American women than in white women. This is because inadequate breast cancer screening causes delayed diagnosis of breast cancers that are more aggressive.
ALL women -- no matter their age, ethnicity, economic status, or insurance status -- deserve the best care and the best prognosis possible if breast cancer develops. Genetic differences can't be eliminated, but other differences that affect prognosis -- screening, access to care, and quality and consistency of care -- should be eliminated.
Screening is a good place to start. Genetic differences aside, breast cancer that is diagnosed early is typically easier to treat and offers the best survival chances. Regular screening for breast cancer, including annual mammograms and breast exams by a medical professional, is important for everyone. Paying for healthcare can be difficult, especially if you have limited income and no or inadequate health insurance or are covered only by Medicare. But if you're older than 40, skipping regular mammograms is NOT an option. Stick with the screening plan you and your doctor decide is best for you. If scheduling problems or cost concerns are stopping you from getting a mammogram, talk to your doctor, a hospital social worker, or a staff member at a mammogram center. Ask about free mammogram programs and healthcare services in your area. It's YOUR health and YOUR future and you deserve the best care possible.