Eliminating racial disparities in breast cancer outcomes in Boston
womeninpink.png
 

Our Mission

To convene a diverse group of multidisciplinary stakeholders who will work together to identify, develop and implement solutions with the goal of eliminating the disparities in breast outcomes and care that exist among Black women by promoting equity and excellence in care for all.

 

Our Vision

The vision of the Boston Breast Cancer Equity Coalition is to eliminate the differences in breast cancer care and outcomes by promoting equity and excellence in care among all women of different racial/ethnic groups in the City of Boston.

The coalition strives to reach this vision by identifying, developing and implementing solutions with the specific initial goal of eliminating the inequities in breast outcomes and care that exist among Black, non-Hispanic women in Boston.

headshot-placeholder-horizontal.jpg

Coalition History

In the City of Boston, inequities in breast cancer mortality have persisted among Black, non-Hispanic women compared to women of other racial/ethnic groups. These inequities were reported in a national study of breast cancer mortality in the largest U.S. cities (Hunt BR et al., Cancer Epidemiology, 2014 Apr. 38:118-23) and confirmed in local, more current data from the City of Boston and Commonwealth of Massachusetts public health departments.


In early 2014, the Boston Public Health Commission and the Dana-Farber Cancer Institute convened a meeting of a group of stakeholders to review available data and emerging research, and to discuss strategies to address the problem. From this stakeholder group, the Boston Breast Cancer Equity Coalition (BBCEC) was formed.


The Coalition is comprised of a diverse group of multidisciplinary stakeholders who have a history of collaboration which include non-profits, government agencies and multiple institutions in Boston where breast cancer patients receive their care. Members include oncology and primary care clinicians, patient navigators, public health policy makers; advocates, researchers and patients.

 

headshot-placeholder-horizontal.jpg

Health Equity

A recent article in Cancer Epidemiology by Hunt et al has triggered renewed interest in developing a coordinated city response to persistent disparities in female breast cancer mortality between Blacks and Whites. The Boston Public health Commission's Research and Evaluation Office conducted an independent analysis reviewing Boston data from a 12-year period and confirmed the findings of Hunt et al. Despite the targeted efforts to address the identified inequities in breast cancer mortality during the time-period reviewed between 2001-2012, the Commission's analysis found that there is an expanding breast cancer mortality gap between Black and White women in the City of Boston and that Black women are dying from breast cancer at younger ages than White women. 

 
DSC_0226.jpg

Dan Dooley of the Boston Public Health Commission presented data relative to the disparities in female breast cancer mortality in the city of Boston.

Key Findings 2001-2012:

  • Mortality Disparity: The overall female breast cancer mortality in the City of Boston has decreased for all races/ethnicities. However, the decreases in mortality for Black women are not statistically significant.
  • Age-Adjusted Mortality: BPHC data reflects that between 2007-2012, Black women between the ages of 35-44 experienced a 166% higher mortality rate compared to White women of the same ages. Similarly, Black women between the ages 45-54 experienced a 68% higher mortality rate than their White counterparts.
  • Screening Rate: Black women ages 40+ in the City of Boston have a higher mammography screening rate than White women (88%, vs. 83%, respectively) 
  • Excess Deaths: In calculating excess deaths from the expected and observed mortality of Black and White women in the City of Boston during the 12 year period reviewed, Black women experienced 74 excess deaths among women under the age of 65
 

Black Women have the Highest Breast Cancer Mortality in Boston  

Figure 1. Female Breast Cancer Mortality* by Race/Ethnicity Boston Residents, 2001-2012 *Average annual (i.e. annualized 12-year) age-adjusted rates. B>A, L, W Note: Death data for 2012 are preliminary and should be interpreted with caution. Until data are final, some changes in data values may occur during data quality processes. DATA SOURCE: Boston Resident Deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office B:W+25

Figure 1. Female Breast Cancer Mortality* by Race/Ethnicity Boston Residents, 2001-2012

*Average annual (i.e. annualized 12-year) age-adjusted rates. B>A, L, W

Note: Death data for 2012 are preliminary and should be interpreted with caution. Until data are final, some changes in data values may occur during data quality processes. DATA SOURCE: Boston Resident Deaths, Massachusetts Department of Public Health DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office B:W+25

Between 2001-2012 black women in Boston were 25% more likely to die of breast cancer than white women. Black and white women had much higher mortality rates than Latina and Asian Boston residents. The Boston Breast Cancer Equity Coalition aims to identify factors that contribute to this mortality gap and implement interventions to reduce it. 

 

Breast Cancer Mortality Rates in Boston are Increasing

Figure 2: Boston Female Breast Cancer Mortality* according to race and time period 2 * average annual (i.e., annualized 6-year) age-adjusted rates. Bold data labels indicate significant T1:T2 difference NOTE: Death data for 2012 are preliminary and should be interpreted with caution. Until data are final, some changes in data values may occur during data quality processes. DATA SOURCE:  Boston Resident Deaths, Massachusetts Department of Public Health DATA ANALYSIS:  Boston Public Health Commission Research and Evaluation Office L-61%,W-27%,B-17%,A-31%

Figure 2: Boston Female Breast Cancer Mortality* according to race and time period 2

* average annual (i.e., annualized 6-year) age-adjusted rates. Bold data labels indicate significant T1:T2 difference

NOTE: Death data for 2012 are preliminary and should be interpreted with caution. Until data are final, some changes in data values may occur during data quality processes. DATA SOURCE:  Boston Resident Deaths, Massachusetts Department of Public Health DATA ANALYSIS:  Boston Public Health Commission Research and Evaluation Office L-61%,W-27%,B-17%,A-31%

Breast cancer mortality rates in Boston increase between 2001 and 2012, with the greatest increase occurring among Latina women. Though breast cancer mortality rates among Latina women remain relatively low, rates between 2007-2012 were more than 2.5 times higher than in 2001-2006. 

 

Mammography Screening Rates are Similar Between Racial Groups

Figure 3. Proportion of Female Boston Residents Ages 40+ Reporting a Mammogram During Past 2 Years DATA SOURCE: Boston Behavioral Risk Factor Survey 2001, 2003, 2005, 2006, 2008, 2010, 2013, Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

Figure 3. Proportion of Female Boston Residents Ages 40+ Reporting a Mammogram During Past 2 Years

DATA SOURCE: Boston Behavioral Risk Factor Survey 2001, 2003, 2005, 2006, 2008, 2010, 2013, Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

Higher mortality among black female Boston residents does not appear to be driven by mammography screening. According to data from the Boston Behavioral Risk Factor Survey, black and white women have very similar rates of mammography, and screening rates have been stable over time. While Asian women have the lowest breast cancer mortality rates in Boston, they also have the lowest rates of mammography. Because of data like this, the BBCEC will focus our efforts to reduce mortality disparities on factors after screening, like follow-up of abnormal mammograms, delays in treatment, and treatment quality. 

Executive Committee Members:

  • Tracy Battaglia
    Boston Medical Center
     
  • Karen Burns White,
    Dana-Farber/Harvard Cancer Center
     
  • Rachel Freedman
    Dana-Farber Cancer Institute
     
  • Karen Freund
    Tufts Medical Center

 

  • Susan Gershman
    MA Department of Public Health
     
  • Anne Levine
    Dana-Farber Cancer Institute
     
  • Gerry Thomas
    Boston Public Health Commission
     
  • Katherine Flaherty
    KF Flaherty Consulting

Membership

 

 

Organizations include:

  • American Cancer Society

  • Asian Women for Health

  • Beth Israel Deaconess Medical Center

  • Boston Medical Center

  • Boston Public Health Commission

  • Brigham and Women's Hospital

  • Dana-Farber Cancer Institute

  • Dana-Farber/Harvard Cancer Center

  • Faulkner Hospital

  • MA Department of Public Health

  • Massachusetts General Hospital

  • Medical-Legal Partnership | Boston

  • Susan G. Komen New England

  • Tufts Medical Center

  • Region 1, USDHHS, Office of the Assistant Secretary for Health

  • YWCA Boston

Contact us

Interested in learning more or getting involved? 
Please contact us at BostonBCEC@gmail.com

headshot-placeholder-horizontal.jpg