Abstract
Background: Breast cancer mortality is significantly higher in pre-menopausal African American women than in age-matched Caucasian women (38.4 vs. 23.0 deaths/100,000). Durham County has one of the highest rates of breast cancer death for African American women in the State of North Carolina (47.2 deaths/100,000 versus 26.5/100,000 for Caucasian women), with rates in North Carolina well higher than national averages. The causes of these disparities are complex, but likely include lack of access to care, cultural norms regarding preventive screening, and the high frequency of clinically aggressive triple-negative breast cancer in African American women. Survival rates for pre-menopausal African American women with triple negative breast cancer are extremely poor, with only 14% of women alive five years after diagnosis.
Our outreach studies provide evidence that one key to reducing breast cancer death is to identify high-risk women before (rather than after) women present with invasive breast cancer. However, there are many barriers to identifying breast cancer risk in African American women, including cultural barriers, education, mistrust, and hesitancy to participate in clinical trials.
Hypothesis: High-resolution geospatial analysis can be used to 1) identify neighborhoods with a high incidence of early onset breast cancer in African American women, 2) target outreach services, and 3) rapidly tracking response to community partnered interventions.
Methods: We used high-resolution geospatial mapping to develop point density maps of: 1) family history of breast cancer; 2) invasive breast cancer; 3) pre-cancer; and 4) mammography, for all women, Caucasian women, and African American women. We evaluated women of all ages and women <50 years of age. Point density is an aggregation method used to show the magnitude of points per unit area. For all women, the ratio of the incidence of pre-breast cancer versus invasive cancer was roughly 1:1. However, the ratio for African American women under the age of 50 was 1:8, demonstrating that women <50 were presenting to the health system with invasive breast cancer (rather than pre-cancerous changes). Women <50 underwent mammography, but our preliminary data suggest that African American women under 50 primarily underwent mammography only when presenting with breast symptoms.
Conclusion: High-resolution geospatial mapping allowed us to 1) identify Durham neighborhoods with the highest incidence and rate of young African American women with early onset breast cancer and 2) demonstrated that African American women under the age of 50 were only undergoing mammography when presenting with a breast mass. We are currently using geospatial mapping to target Navigator sponsored community education and provide free breast screening through neighborhood community centers and free clinics. Geospatial mapping will be used to track the effectiveness of our community partnered interventions.
Citation Information: Cancer Prev Res 2010;3(12 Suppl):B7.
RSS Feeds