title: A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change.
abstract: It is well known that there is a significant racial divide in breast cancer incidence and mortality rates. African American women are less likely to be diagnosed with breast cancer than white women but are more likely to die from it. This review explores the factors that may contribute to the racial survival disparity. Consideration is paid to what is known about the role of differences in tumor biology, genomics, cancer screening, and quality of cancer care. It is argued that it is the collision of 2 forces, tumor biology and genomics, with patterns of care that leads to the breast cancer mortality gap. The delays, misuse, and underuse of treatment for African American patients are of increased significance when these patients are presenting with more aggressive forms of breast cancer. In the current climate of health care reform ushered in by the Affordable Care Act, this article also evaluates interventions to close the disparity gap. Prior interventions have been too narrowly focused on the patient rather than addressing the system and improving care across the continuum of breast cancer evaluation and treatment. Lastly, areas of future investigation and policy initiatives aimed at reducing the racial survival disparity in breast cancer are discussed.
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Bobby
authors.initials: B
authors.lastname: Daly
authors.affiliation: Walter L. Palmer Distinguished Service Professor and Director Center for Clinical Cancer Genetics, Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Olufunmilayo I
authors.initials: OI
authors.lastname: Olopade
mesh_terms: D001741:Black or African American; D014408:Biomarkers, Tumor / Q000235:genetics; D001943:Breast Neoplasms / Q000208:ethnology* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D003695:Delivery of Health Care; D055088:Early Detection of Cancer; D005260:Female; D023281:Genomics; D018166:Health Care Reform; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D058991:Patient Protection and Affordable Care Act; D011379:Prognosis; D011787:Quality of Health Care; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People
chemical_list: D014408:Biomarkers, Tumor
keywords: breast cancer; disparities research; health services research; precision medicine