Conclusion

Breast cancer has a major effect on the health of black women in the United States. The incidence of breast cancer is lower in black women than in white women, predominantly because of a lower risk in the elderly that may be explained by variations in reproductive history. However, once cancer develops, black women have a dramatically worse prognosis; their 5-year survival rate is 64%, and that of white women is 80%. The poor prognosis may result because of the more advanced cancer at diagnosis in black women, because of the differences in tumor biology between black women and white women, because of socioeconomic factors, and possibly because of differences in treatment.

To close the survival gap between black and white women, a combination of further research and focused intervention is necessary. In the research arena, it is particularly important to develop a better understanding of the treatment options available to all black women, the choices these women make about therapy, and the efficacy of therapy in black women and white women. Because the tumors of black women are more histologically aggressive and are diagnosed at a more advanced stage, appropriate and intensive adjuvant therapy will be vital in attempts to improve survival in these patients. The methods used to effectively deliver this therapy to economically disadvantaged women and women with serious comorbid conditions also needs more attention.

Continued efforts to encourage early detection and treatment are important, especially those that focus on poor women, the elderly, and women without a consistent source of health care—all groups that have been recognized as less likely to receive yearly mammography. Black women are disproportionately affected by the economic barriers to early detection and should also be a focus of early detection interventions. It is hoped that, with a combination of early detection programs, more effective ways to deliver high-quality care to the economically disadvantaged, and a better understanding of the determinants of breast cancer biology, the next century will see substantial gains in the survival of black women with breast cancer.

Author and Article Information
From the University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. For the current author address, see end of text.
Requests for Reprints: Jill Moormeier, MD, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108.

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