Exploring and Crossing the Disparity Divide in Cancer Mortality

Disparities in access to health care and in health outcomes are a significant challenge in the United States. A disproportionate burden of deaths due to cancer is borne by black populations for breast, colorectal (1), and cervical (2, 3) cancer and by persons with lower educational levels for most types of cancer (1, 4, 5). Hispanic women have higher rates of late-stage cervical cancer diagnoses than do non-Hispanic white women (1). The excess burden of death from breast cancer among African-American women occurs despite a lower incidence of breast cancer than that for white women (6).

Current evidence-based methods of screening for colon, cervical, and breast cancer (7-9) enable early detection of lesions, but access to and use of these screening tests vary by race and socioeconomic status. The general trend is that minority persons and those with lower incomes have lower rates of screening (1, 10). Encouraging data from the recent National Health Interview Survey (11) and Behavioral Risk Factor Surveillance Survey (12) that report similar use of mammography across racial groups rely on self-report, an approach that lends itself to inaccuracies (13).

This issue includes 2 articles relevant to cancer screening in special populations. One article from the Breast Cancer Surveillance Consortium (BCSC) reports on 2 potential sources of the disproportionate burden of death due to breast cancer borne by African-American women (14). The second article describes the results of a randomized, controlled trial aimed at countering 1 of those sources, namely less frequent mammography screening. This group tested “prevention coaches” as a means to increase use of cancer screening services by largely Hispanic and African-American patients at community and migrant health centers in New York City (15).

Smith-Bindman and colleagues (14) used mammography registry data pooled in the BCSC …