Race-specific impact of natural history, mammography screening, and adjuvant treatment on breast cancer mortality rates in the United States

Nicolien T. Van Ravesteyn, Clyde B. Schechter, Aimee M. Near, Eveline A M Heijnsdijk, Michael A. Stoto, Gerrit Draisma, Harry J. De Koning, Jeanne S. Mandelblatt

Research output: Contribution to journalArticle

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Abstract

Background: U.S. Black women have higher breast cancer mortality rates than White women despite lower incidence. The aim of this study is to investigate how much of the mortality disparity can be attributed to racial differences in natural history, uptake of mammography screening, and use of adjuvant therapy. Methods: Two simulation models use common national race, and age-specific data for incidence, screening and treatment dissemination, stage distributions, survival, and competing mortality from 1975 to 2010. Treatment effectiveness and mammography sensitivity are assumed to be the same for both races. We sequentially substituted Black parameters into the White model to identify parameters that drive the higher mortality for Black women in the current time period. Results: Both models accurately reproduced observed breast cancer incidence, stage and tumor size distributions, and breast cancer mortality for White women. The higher mortality for Black women could be attributed to differences in natural history parameters (26-44%), use of adjuvant therapy (11-19%), and uptake of mammography screening (7-8%), leaving 38% to 46% unexplained. Conclusion: Black women appear to have benefited less from cancer control advances than White women, with a greater race-related gap in the use of adjuvant therapy than screening. However, a greater portion of the disparity in mortality appears to be due to differences in natural history and undetermined factors.

Original languageEnglish (US)
Pages (from-to)112-122
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume20
Issue number1
DOIs
StatePublished - Jan 2011

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Mammography
Natural History
Breast Neoplasms
Mortality
Therapeutics
Incidence
Survival
Neoplasms

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

Cite this

Race-specific impact of natural history, mammography screening, and adjuvant treatment on breast cancer mortality rates in the United States. / Van Ravesteyn, Nicolien T.; Schechter, Clyde B.; Near, Aimee M.; Heijnsdijk, Eveline A M; Stoto, Michael A.; Draisma, Gerrit; De Koning, Harry J.; Mandelblatt, Jeanne S.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 20, No. 1, 01.2011, p. 112-122.

Research output: Contribution to journalArticle

Van Ravesteyn, Nicolien T. ; Schechter, Clyde B. ; Near, Aimee M. ; Heijnsdijk, Eveline A M ; Stoto, Michael A. ; Draisma, Gerrit ; De Koning, Harry J. ; Mandelblatt, Jeanne S. / Race-specific impact of natural history, mammography screening, and adjuvant treatment on breast cancer mortality rates in the United States. In: Cancer Epidemiology Biomarkers and Prevention. 2011 ; Vol. 20, No. 1. pp. 112-122.
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