The excess burden of breast carcinoma in minority and medically underserved communities: application, research, and redressing institutional racism.
BACKGROUND
In 1998, the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention reported an overall downward trend in cancer incidence and mortality between 1990 and 1995 for all cancers combined. Many minority and medically underserved populations, however, did not share equally in these improvements.


METHODS
A review of surveillance and other reports and recent literature on disparities in cancer incidence and mortality in minority and medically underserved communities was conducted 1) to ascertain the extent to which these communities bear an excess cancer burden, and 2) to explore the macrosocietal and microinstitutional barriers to equitable benefits in cancer health care delivery.


RESULTS
Tragic disparities in cancer incidence and mortality in minority and medically underserved communities continue to be inadequately addressed. Overall improvements in U.S. cancer incidence and mortality rates are not shared equally by all segments of our society. While numerous individual and cultural barriers to optimal cancer control and care exist in minority and medically underserved communities, a major factor precluding these populations from sharing equally in advances in cancer research is prevailing societal and institutional racism.


CONCLUSIONS
Immediate and equitable application of existing cancer control interventions and quality treatment options will significantly decrease cancer incidence and mortality. Enhanced surveillance efforts and a greater investment in targeted cancer research in those communities with the greatest disparities must be employed immediately if we are to achieve the goal of the president of the United States of eliminating racial and ethnic disparities in cancer and other diseases by 2010. Unless we acknowledge and redress institutionalized racism, the miscarriage of health justice will be perpetuated while celebrated advances in cancer research leading to declining incidence and mortality rates continue to evade our nation's minority and medically underserved communities.
Shinagawa
S M
SM
Chair, Intercultural Cancer Council, Houston, Texas, USA.
D001943:Breast Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control; D002277:Carcinoma / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control; D003159:Community-Institutional Relations; D003469:Culture; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008507:Medically Underserved Area; D008913:Minority Groups / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011287:Prejudice; D012106:Research; D012935:Social Justice; D014481:United States / Q000453:epidemiology