1. Health Disparities: Breast Cancer in African AmericansIn Lansing Health Disparities: Breast Cancer in African Americans In Lansing Costellia Talley, PhD, ACNS-BC

2. Outline Define cancer health disparities Describe factors related to health disparities Provide evidence of disparities in: –Health status –Health care delivery –Cancer survival Describe efforts to reduce health disparities

3. Cancer Health Disparity The NCI defines “cancer health disparities” as "differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States.“

4. Populations Population Groups Other Special Populations American Indian/Alaska Native (AI/AN) Asian American Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander Socio economic status Geography (urban or rural) Gender Age Disability status Risk status related to sex and gender

5. Underserved Populations More likely to be : Diagnosed with, and die from breast cancer; Diagnosed with late-stage disease for cancers that are Receive either no treatment or treatment that does not meet currently accepted standards of care; Die of cancers that are generally curable Receive inadequate pain control and other palliative care (terminal cancers)

6. Healthy People 2020 A goal of Healthy People 2020 goals is to achieve health equity, eliminate health disparities and improve the health of all groups

7. Background African Americans have the highest overall cancer mortality rates nationwide African American women have lower survival rates compared to whites due to later stage at detection and poorer-stage specific survival Persons with low socioeconomic status tend to have poorer cancer survival rates

8. Background African American women have the highest death rate among minority populations African American women are 34% more likely to die of cancer than White women, partly due to stage at diagnosis Even at the same stage of diagnosis, African-American women show lower survival rates.

9. Breast Cancer in Michigan In 2009, African Americans had: –A higher death rate –Higher number of new cases African Americans have lower five-year cancer survival rates Disparities at each level of the continuum –Screening, diagnosis, referral for treatment, treatment

10. Demographics of Lansing 12% of Lansing’s population is African American Ingham County has 19.1 percent of persons living below the poverty level compared to a US average of 14.3 percent 10% of the population in Ingham county do not have health insurance

11. Lansing has a high percentage of Stage III and Stage IV tumors Incidence is highest among white women Mortality is highest among racial minorities, partly due to a later stage at diagnosis Breast Cancer in Lansing

12. Even at the same localized stage of diagnosis, African American women show lower survival rates than white women Breast Cancer in Lansing

13. Barriers to Care (Qualitative) Individual Barrier Lack of Knowledge –Fear of the mammography screening process –Lack of perceived chance of breast cancer diagnosis i.e., family medical history on their risk of breast cancer –Lack of knowledge and awareness of breast health care

14. Barriers to Care BARRIERS RELATED TO CULTURE Spirituality Cultural Beliefs and Attitudes Perceived Susceptibility to Breast Cancer Medical mistrust

15. Barriers to Care BARRIERS RELATED TO SOCIAL INJUSTICE Unequal treatment given by doctors –Different referrals, recommendations The perception of racism

16. Barriers to Care INSTITUTIONAL BARRIERS Provider lack of communication and awareness Cost and insurance Distance to services

17. Barriers to Care Gap in services in the area for women with breast health concerns who are under 40 years old Limited services for those aged 40-49.

18. 2009-2015 Goals: Cancer Survivorship Goal # 1: Improve the quality of life for cancer survivors in Michigan Survivorship covers the physical, psychosocial, and economic issues of cancer, from diagnosis until the end of life. Michigan Cancer Consortium Comprehensive Control for Michigan

19. Survivorship Care Prevention and detection of new cancers and recurrent cancer; Surveillance for cancer spread, recurrence, or second cancers;

20. Survivorship Care Intervention for consequences of cancer and its treatment; and Coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met.

21. Opportunities to Reduce Disparities Educate African American women about breast cancer outcomes Work within health systems to improve physician/patient communication Continue to promote screening – but focus on improving follow-up care for African Americans

22. References Healthy People 2020. Access online at: http://www.healthypeople.gov/2010/hp2020/Objectives/framework.aspx Michigan Cancer Consortium. (2012). Mapping a Course for Excellence in Michigan Comprehensive Cancer Control Plan for Michigan, 2009 – 2015 http://www.michigancancer.org/CancerPlan/ComprehensiveCancerControlPlan -2009-2015.cfm Michigan Department of Community Health. 2009 Health Disparities Report. Access online at: http://www.michigan.gov/documents/mdch/86690- 2009_Health_Disparities_Report_MDCH_final_2_21_10_2_314185_7.pdf Michigan Public Health Institute and Michigan Department of Community Health. The Cancer Burden in Michigan: Selected Statistics 1990-2009. June 2010. Access online at: http://www.michigancancer.org/WhatWeDo/TheCancerBurdenMichiganSele ctedStatistics.cfm.

23. References Michigan Public Health Institute and Michigan Department of Community Health. Special Cancer Behavioral Risk Factor Survey, 2008. April 2010. Access online at: http://www.michigancancer.org/Resources/SpecialMCCReports.cfm. National Cancer Institute. Center to Reduce Cancer Health Disparities Access online at: http://crchd.cancer.gov/disparities/defined.html Susan G. Komen for the Cure Mid-Michigan. (2011). http://www.komenmidmichigan.org/grants/ http://www.komenmidmichigan.org/grants/