Exploring Factors for Lower Mortality Rates of African American Women in Oregon

Background and Specific Aims:
Breast cancer is one of the most common cancers in the United States, resulting in 1 in every 3 cancers diagnoses. (Smigal, 2006) Caucasian women are known to have higher incidence rates but, more than any other racial or ethnic group, African American women are known for higher mortality in breast cancer. (Lukwago, 2003). Cancer experts say many cases can be treated with early screening, but ethnic groups are less likely to receive breast cancer screening, resulting with late stage diagnosis and shortened survival rate in many African American women. (Alteri, 2011 & Bradley, 2002) Disparities also play a role in the high death rate, as disparities in health care quality, access to care, education and socioeconomic disadvantages create barriers for screening, diagnosis and treatment. (Albano, 2007 & Newman, 2002)  Breast cancer incidence and mortality rates generally increase with age (Alteri, 2011), but cultural, environmental, biological, and lifestyle factors have an influence as well (Ward, 2004). According to the American Cancer Society 2012 Breast Cancer Surveillance Research in the U.S., African American mortality rates are 32.4 per 100,000 people, compared to Caucasians at 23.9.  Nebraska, a state with a small ethnic population, is comprised of 13.7% African Americans, with almost 57,000 residents in the state’s largest city, Omaha.  Breast cancer rates in Nebraska also follow the general trend, with a death rate of 29.9 for Blacks when compared to 22.3 for Whites. (Alteri, 2011)  In Oregon African Americans make up 2% of the population, with 6.3%, or over 37,000, African Americans residing in its major metropolitan area, Portland. Unlike Nebraska however, mortality rates are 19.9 for African Americans and 23.9 for Caucasians, reflecting lower death rates for Blacks.  Cancer is the leading cause of death of Oregon residents (Alteri, 2011) and although African Americans make up a small percentage of residents, populations are almost similar to that of Nebraska, sharing similarities in populations, socioeconomic status and poverty rates, and even similar social determinants of health.  There is little information regarding the reasons of the trend, but we believe Oregon’s mortality rates are lower from a result of early screening and healthy diet and behavior. To investigate the differences in the two populations we plan to:  
1. Develop a survey to investigate the factors contributing to the lower mortality rate in female African American Oregon residents.
2. Administer the survey to African American women in Portland, Oregon and Omaha, Nebraska, comparing the contributing factors of breast cancer in Oregon to those of a similar population.
3. Evaluate the survey and explore Oregon and Nebraska’s socioeconomic status data and compare to those to the survey findings and African American women in United States.

References:
1. Alteri, Rick, MD, Priti Bandi, MS, and Louise BRinton, PhD. Breast Cancer Facts & Figures 2011-2012. Rep. Atlanta: American Cancer Society, 2011. Print.
2. Albano, J. D., E. Ward, A. Jemal, R. Anderson, V. E. Cokkinides, T. Murray, J. Henley, J. Liff, and M. J. Thun. "Cancer Mortality in the United States by Education Level and Race." JNCI Journal of the National Cancer Institute 99.18 (2007): 1384-394. Print.
3. Bradley, Cathy J., Charles W. Given, and Caralee Roberts. "Race, Socioeconomic Status, and Breast Cancer Treatment and Survival." Journal of the National Cancer Institute 94.7 (2002): 490-96. Print.
4. Lukwago, S. N., M. W. Kreuter, C. L. Holt, K. Steger-May, D. C. Bucholtz, and C. S. Skinner. "Sociocultural Correlates of Breast Cancer Knowledge and Screening in Urban African American Women." American Journal of Public Health 93.8 (2003): 1271-274. Print.
5. Newman, Lisa A., James Mason, David Cote, Yael Vin, Kathryn Carolin, David Bouwman, and Graham A. Colditz. "African-American Ethnicity, Socioeconomic Status, and Breast Cancer Survival." Cancer 94.11 (2002): 2844-854. Print.
6. Smigal, Carol, MPH, Ahmedin Jemal, DVM, PhD, and Elizabeth Ward, PhD. "Trends in Breast Cancer by Race and Ethnicity: Update 2006." A CAncer Journal for Clinicians 56 (2006): 168-83. Print.

Raheem Sanders
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