Year: 2023
Type: article
Abstract: BACKGROUND: Populations of African American or Black women have persistently higher breast cancer mortality than the overall US population, despite having slightly lower age-adjusted incidence. METHODS: Three Cancer Intervention and Surveillance Modeling Network simulation teams modeled cancer mortality disparities between Black female populations and the overall US population. Model inputs used racial group-specific data from clinical trials, national registries, nationally representative surveys, and observational studies. Analyses began with cancer mortality in the overall population and sequentially replaced parameters for Black populations to quantify the percentage of modeled breast cancer morality disparities attributable to differences in demographics, incidence, access to screening and treatment, and variation in tumor biology and response to therapy. RESULTS: Results were similar across the 3 models. In 2019, racial differences in incidence and competing mortality accounted for a net ‒1% of mortality disparities, while tumor subtype and stage distributions accounted for a mean of 20% (range across models = 13%-24%), and screening accounted for a mean of 3% (range = 3%-4%) of the modeled mortality disparities. Treatment parameters accounted for the majority of modeled mortality disparities: mean = 17% (range = 16%-19%) for treatment initiation and mean = 61% (range = 57%-63%) for real-world effectiveness. CONCLUSION: Our model results suggest that changes in policies that target improvements in treatment access could increase breast cancer equity. The findings also highlight that efforts must extend beyond policies targeting equity in treatment initiation to include high-quality treatment completion. This research will facilitate future modeling to test the effects of different specific policy changes on mortality disparities.
Source: JNCI Monographs
Institutions: Georgetown University Medical Center, Georgetown Lombardi Comprehensive Cancer Center, Albert Einstein College of Medicine, Harvard University, Harvard Pilgrim Health Care, Dana-Farber Cancer Institute, Dana-Farber/Harvard Cancer Center, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, University of Wisconsin–Madison, University of Wisconsin Carbone Cancer Center, National Institutes of Health, National Institute on Minority Health and Health Disparities, Kaiser Permanente Washington Health Research Institute, Virginia Commonwealth University, VCU Massey Comprehensive Cancer Center
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs, Georgetown University, National Institutes of Health, National Institute on Aging, National Cancer Institute, National Institute on Minority Health and Health Disparities, NHLBI Division of Intramural Research
Awards: G1561916700, Comparative Modeling: Informing Breast Cancer Control Practice and Policy, Comparative Modeling of Precision Breast Cancer Control Across the Translational Continuum, Bio-behavioral Research At The Intersection of Cancer and Aging, I-REACH: Infrastructure for Research in Equity, Aging, Cancer and Health, I-REACH (Infrastructure for REsearch on Cancer and Aging), Georgetown University Lombardi Comprehensive Cancer Center Support Grant, Investigations CONNECTing Cancer and Aging (I-CONNECT), UW Comprehensive Cancer Center Support, Advancing Risk-based Breast Cancer Screening and Surveillance in Community Practice
OpenAlex ID: W4388557313