Abstract
Background: Breast cancer is the most common cancer diagnosed among women and the leading cause of cancer death among women worldwide. Since 1990, breast cancer incidence has remained stable and mortality has decreased 2% per year in the U.S. However, ethnic minority and socioeconomically disadvantaged women have not experienced these gains in breast cancer outcomes. Understanding shared factors at different levels across disparities may be helpful for improving the well-being of multiple marginalized populations in the U.S. as well as potentially in other countries.
Methods: We conducted an integrative, qualitative review of the literature from 2008-2018 to describe the burden of breast cancer and multilevel interventions to address disparities among three unique, underserved groups in the U.S. We searched Google Scholar and PubMed as well as county, state, and national public health databases and summarized the relevant literature.
Results: African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State represent three subgroups in the U.S. who suffer disproportionately from breast cancer, including late-stage diagnoses, aggressive subtypes, and poor survival. These characteristics are influenced by biologic, individual, social, and societal factors including gene expression, fear and fatalism, poverty and neighborhood, and access to care. Multilevel interventions across the three geographic areas have included patient navigation and community health workers to bolster education and enhance health care access, support groups, and political advocacy.
Conclusion: African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State share disproportionate exposure to a myriad of social determinants of health that contribute to lower rates of breast cancer detection and treatment as well as poorer survival. Concerted efforts that address these factors are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources.
Citation Format: Sarah D. Hohl, Beti Thompson, Yamile Molina, Electra D. Paskett. Multilevel approaches to breast cancer disparities in the United States: An integrative review [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A021.
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