By: Alexia Achu, Catherine Phamduy, & Yen Phan

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Female Breast Composition

Lobules: milk producing glands Ducts: ducts that carry the milk

from the lobules to the nipple Stroma: fatty tissue and connective tissue surrounding the ducts, lobules, blood vessels, and lymphatic vessels.

2 NIH: National Cancer Institute

Female Breast Anatomy

Important Definitions Cancer: uncontrolled abnormal cell growth

Breast cancer: arises from abnormal cell growth in the breast

tissue

3 MRI of a healthy breast (left) versus MRI of a breast

containing a tumor (right)

Genetic and Hormonal Factors

Specific inherited mutations in BRCA1 & BRCA2

o genes that normally work to prevent cancer from developing

Hormone testing

o hormone (estrogen and progesterone) receptors and HER2/neu receptors

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What are Health Disparities?

Health Disparities:

preventable differences in the incidence, prevalence, mortality and burden of diseases and other adverse health conditions that exist among specific population in the United States

-N.I.H

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Why is Breast Cancer Mortality a Health Disparity?

African American women have a higher breast cancer mortality rate than the general population in the state of Massachusetts.

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Breast Cancer Mortality Statistics in Massachusetts

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Year 2011

Kff.org/state-category/womens-health/?state=MA

Contributing Factors to Breast Cancer Disparity

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Socioeconomic -Lack of Transportation -Lack of Education -Poor Health Insurance -Cultural Barrier -Income

Access to Health Care -Delay of diagnosis -Delivery of healthcare -Treatment delay -Lack of follow-up

Lifestyle -Overweight & Obese -Unhealthy Diet

Genetic -Triple Negative Breast Cancer

Breast Cancer Disparity

Socioeconomic Status-Poverty Rate

9 http://www.umb.edu/editor_uploads/images/centers_institutes/center_social_policy/Poverty_in_Massachusetts_by_Race.pdf

Socioeconomic Status –Quality of Health Insurance

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Medicaid Coverage Rates for the Nonelderly by Race/Ethnicity in 2013

http://kff.org/medicaid/state-indicator/rate-by-raceethnicity-3/?state=MA

Quality of Health Care in Massachusetts

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Year 2013 Kff.org/state-category/womens-health/?state=MA

Access to Health Care - Treatment

Delay in diagnosis

Treatment delay

Lack of follow-up Poor treatment

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Lifestyle

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Race State 3-Year %

White Non-Hispanic

21.7 (21.1- 22.4)

Black Non-Hispanic

30.6 (27.5- 33.6)

Hispanic 29.1 (26.3 - 31.8)

Asian Pacific Islander

8.1 (5.3 - 10.9)

Obese Based on Body Mass Index by Race in Massachusetts

http://www.mass.gov/eohhs/researcher/community-health/masschip/health-

risk-factors-racehispanic-ethnicity-report.html

Genetic Factors

Triple-negative-hormone/Hormone-negative tumors – Triple Negative Breast Cancer: poorer prognosis

due to a lack of a targeted treatment for triple negative cancers in comparison to other breast cancers.

14 http://economictimes.indiatimes.com/news/science/scientists-identify-gene-behind-triple-negative-breast-cancer

Undoing the Disparity- New Methods

A new method that predicts breast cancer risk specifically for African American women

Using this model expands the

care for African American women at relative risk rather than absolute risk.

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Undoing the Disparity

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Summary

Mortality rate of breast cancer in MA is higher in African American women

Contributing factors

Hopes for change

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Questions?

18 http://health.clevelandclinic.org/2014/02/14-questions-about-your-breast-cancer-diagnosis/

References • Albelda, R., Carre, F., Cheah ,E., and Marcellot L. Poverty on Massachusetts by Race, ACS 2008-2012

estimates. Center for Social Policy. 2014.

• Are there different kinds of breast cancer? Centers for Disease Control and Prevention. 21, Jul. 2014.

• Breast Cancer. American Cancer Society. Feb. 2014.

• Cancer Health Disparities. National Cancer Institute. 11, Mar. 2008.

• Disparities in Breast Cancer Screening. Susan G. Komen. 22, Jan. 2015.

• Disparities in Breast Cancer: Through the Breast Cancer-Care Continuum. Breast Cancer Action. Nov. 2013

• Levy, D.E. Underutilization of BRCA1/2 testing to guide breast cancer treatment: Black and Hispanic women

particularly at risk. Genetics in Medicine. 2011 13

• Massachusetts comprehensive cancer prevention and control plan: 2012-2016. Massachusetts Department of

Public Health.

• McCormick, Cynthia. Cape breast cancer statistics called ‘scary.’ Cape Cod Times. 10, Jan. 2012.

• O'Keefe EB, Meltzer JP and Bethea TN (2015) Health disparities and cancer: racial disparities in cancer mortality

in the United States, 2000-2010. Front. Public Health 3:51.

• Pande, A et al. Effects of Healthcare Reforms on Coverage, Access, and Disparities: Quasi-Experimental Analysis

of Evidence from Massachusetts. American Journal of Preventive Medicine. Jul 2011. 14:1

• Parise and Caggiano: Disparities in race/ethnicity and socioeconomic status: risk of mortality of breast cancer in

the California Cancer Registry, 2000-2010. BMC Cancer 2013 13:449.

• Tian et al.:Spatial association of racial/ethnic disparities between late-stage diagnosis and mortality for female

breast cancer: where to intervene? International Journal of Health Geographics 2011 10:24

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