African American women have higher rates of breast cancer mortality than any other racial/ethnic group. These disparities persist even after accounting for tumor stage and characteristics. Efforts to reduce disparities have largely focused on breast cancer screening. These efforts have been successful as screening rates between Black and White women have converged over the last decade. Currently breast cancer disparities are found mainly in timely diagnosis and treatment. There is evidence that obtaining cancer treatment at a National Cancer Institute designated-Comprehensive Cancer Center (NCICCC) results in significantly lower mortality than receiving treatment at non-NCICCC. In a population-based study of 69,579 patients (22-65 years of age) newly diagnosed with cancer, Wolfson et al found that women who were diagnosed with breast cancer and who received treatment at a non-NCICCC facility had higher 5-year mortality than women who received treatment at a NCICCC [HR: 1.3 (95%: 1.1-1.7)]. In addition, they found that patients who were underrepresented minority (African American or Hispanic), those who were older (40-65), those who were low SES, those who were uninsured, and those that lived more than 9 miles from the nearest NCICCC were less likely to be treated at a NCICCC. Factors that influence higher survival at NCICCCs include better surgical outcomes, organizational affiliation, and guideline compliance. I'm interested in understanding ways to get African American women, who tend to be lower income, into NCICCCs. The biggest hurdle here is economics; how do we change the types of insurance NCICCCs accept. I assume there must be ways to incentivize health systems.
Wolfson, J. A., Sun, C. L., Wyatt, L. P., Hurria, A., & Bhatia, S. (2015). Impact of care at comprehensive cancer centers on outcome: Results from a population‐based study. Cancer, 121(21), 3885-3893.