Health Care for Minority Women: Heart Disease and Cancer

Minority women continue to fare worse than white women in terms of health status, rates of disability, and mortality. For some conditions, the disparities are growing, despite new technologies and other advances that have been made in recent years.

Minorities are more likely to characterize their health status as fair or poor than whites, and women of all races are more likely to be in fair or poor health than men. Nearly 17% of Hispanic women and more than 15% of black women say they are in fair or poor health, compared with 11% of white women.

Adequate access to health care services can have a significant effect on health care use and health outcomes. Lack of health insurance is a barrier to receiving services. Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured. Furthermore, blacks and Hispanics are much more likely than whites to lack a usual source of care and to encounter other difficulties in obtaining needed care.

Heart Disease

Black women are only 40 percent as likely as white men to be referred for cardiac catheterization.

Schulman, Berlin, Harless, et al.,New England Journal of Medicine 340, pp. 618-626, 1999.

This study found that blacks and women with chest pain had relative odds of referral for cardiac catheterization that were 60% of the odds for whites and men. The disparity was greatest for black women at 40%. Cardiac catheterization is considered to be the "gold standard" test for diagnosing coronary artery disease. The study involved 720 primary care doctors and eight patient actors (two each black men, black women, white men, and white women) who used the same scripts to report identical clinical symptoms. The actors wore identical gowns, used similar hand gestures, and had the same insurance and professions. Biases found in this study may reflect subconscious perceptions of physicians about race and sex, according to the researchers.

White women are twice as likely as black women to have a heart attack.

Maynard, Beshansky, Griffith, and Selker, Journal of the National Medical Association 89(10), pp. 665-671, 1997.

This study involved 6,600 white and 3,401 black patients who arrived at the emergency department with chest pain or other symptoms suggestive of acute cardiac ischemia (ACI). Only 4% of black women were diagnosed with acute myocardial infarction (heart attack) compared with 8% of white women. Twelve percent of black women and 17% of white women were diagnosed with angina pectoris. Chest pain and other symptoms were attributed to ACI in 16% of black women and 25% of white women.

Cancer

Each year, about 185,000 U.S. women are newly diagnosed with breast cancer, and nearly 45,000 women die from this disease. The risk of breast cancer rises with age. Although substantial progress has been made in diagnosing and treating breast cancer, it continues to take a heavy toll, particularly among black women. Breast cancer survival rates rose slightly among white women over the past two decades, yet they declined for black women during the same period. There are several reasons for this disparity, including:

• Black women are more likely than white women to be diagnosed at a later stage when the cancer has spread.
• They may lack access to the most up-to-date treatments.
• They may be biologically at greater risk for more aggressive tumors.

Missed appointments are linked to shorter breast cancer survival for black women.

Howard, Penchansky, and Brown, Family Medicine 30(3), pp. 228-235, 1998.

In this study, nearly four times as many black women as white women missed two or more scheduled appointments before the identification of breast cancer symptoms. This factor nearly tripled the black women's risk of being diagnosed at a later stage. These findings are based on a retrospective review of the clinical records of 246 women receiving care for breast cancer at three health maintenance organizations.

Minority women average slightly later follow-up tests than white women following an abnormal mammogram .

Chang, Kerlikowske, Napoles-Springer, et al., Cancer 78(7), pp. 1395-1402, 1996.

This study found that minority women with abnormal screening mammograms had follow-up tests (another mammogram, ultrasound, fine-needle aspiration, or biopsy) on average about a week later than white women with abnormal mammograms. Researchers examined the records of 317 women and found that this small difference had no impact on breast cancer stage at diagnosis or on mortality, but it occurred even when women's physicians were immediately notified of abnormal results.

Black women do not appear to benefit as much as white women from mammography .

Jones, Kasl, Curnen, et al., Cancer 75, pp. 2103-2113, 1995.

A retrospective study of 322 women diagnosed with their first primary breast cancer found that black women were more likely than white women to have never had a mammogram in the 3-year period before development of symptoms or diagnosis. Although black women are now much more likely to have a mammogram, the study's finding that mammography protects only white women against a later cancer stage at diagnosis remains a cause for concern. The researchers cite the variables that contribute to effective mammographic screening and the inconsistent quality of such screening nationwide.

Blacks are more likely than whites to die from colorectal cancer.

AHCPR'S Colorectal Cancer Screening Technical Review (AHCPR Publication No. 98-0033) documents racial differences in colorectal cancer survival. The 5-year relative survival rate for colon cancer (1983 to 1989) was 61% among white men, 50% among white women, 48% among black men, and 49% among black women. Black men and women with colorectal cancer have a 50% greater probability of dying of colon cancer than white men and women.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.