Journal Article

Perceived racial discrimination in health care in relation to late stage at breast cancer diagnosis

Rosenberg, Lynn, Palmer, Julie R., Holder, Etienne X., Barnard, Mollie E., Ko, Naomi, Xu, Nuo N.

2025

Overview

Background In the U.S., poorer breast cancer survival in Black women relative to white women has persisted for over 30 years, with recent data showing a 38% higher mortality in Black women with breast cancer. Stage at diagnosis is the most powerful predictor of survival. However, despite rates of mammographic screening having become approximately equal in the two groups, Black women are more likely to be diagnosed at later stages. We examined whether perceived experiences of discrimination due to race in receipt of health care is associated with a late stage at diagnosis of breast cancer. Methods Nested within the prospective Black Women’s Health Study (BWHS), this case-only study included 1,617 self-identified U.S. Black women diagnosed with a first invasive breast cancer in 2003 through 2022. Eligible cases had completed a BWHS questionnaire in 2003 in which participants were asked whether they received differential health care due to their race or insurance status. The primary outcome in the present research was stage at breast cancer diagnosis, obtained from medical records and cancer registry data. Odds ratios (OR) for the association of perceived racial discrimination in health care with later stage at diagnosis were estimated in logistic regression analyses, with each of stages II, III, and IV compared with stage I diagnosis. Results In multivariable analyses controlled for age, body mass index, socioeconomic factors, and mammographic screening, perceived racial discrimination in healthcare was associated with an increased odds of breast cancer diagnosis at stage IV versus stage I (OR = 2.10, 95% CI 1.15–3.83). The association was present even among women who reported having a mammogram in the two years before diagnosis. No associations were observed for stage II or III versus stage I. Conclusions The findings support reducing healthcare discrimination to alleviate the disproportionate burden of worse prognosis and survival experienced by Black women.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adult / Aged / Analysis / Biomedical and Life Sciences / Biomedicine / Black or African American - psychology / Breast cancer / Breast Neoplasms - diagnosis / Breast Neoplasms - epidemiology / Breast Neoplasms - ethnology / Breast Neoplasms - pathology / Cancer / Cancer Research / Delayed diagnosis / Diagnosis / Discrimination in medical care / Early Detection of Cancer / Female / Health aspects / Healthcare Disparities - ethnology / Humans / Mammography / Medical records / Middle Aged / Neoplasm Staging / Odds Ratio / Oncology / Oncology, Experimental / Perceived Discrimination - psychology / Prospective Studies / Race discrimination / Racial discrimination / Racism - psychology / Stage at diagnosis / Surgical Oncology / United States - epidemiology / White / White women