Abstract IA37: Integrated multilevel interventions to address the African American and white disparity in breast cancer mortality
Authors: Gehlert Sarah 
Published: October 2015

Abstract
African-American women have a higher death rate from breast cancer than white women (30.8 deaths per 100,000 during 2006 through 2010 for African-American females versus 22.7 per 100,000 for white females during that same period), despite the fact that their rate of incidence is lower (118.4 per 100,000 during 2006 through 2010 for African-American females versus 127.3 per 100,000 for white females during that same period).1 Mortality rates for African-American and white women began to diverge from one another in the early 1980s, and although rates of mortality from breast cancer have decreased for both African-American and white women since the 1990s, the decrease has been greater for white women than for African-American women (a decline in breast cancer death rate of 1.6% from 2001 to 2010 for African-American females compared to a decline of 1.8% for white females during that same period).
The determinants of breast cancer disparities occur at multiple levels of influence, from the cellular to the societal.2 Warnecke et al.3 proposed a multi-level scheme of influence on cancer disparities, with the following six levels that interact with one another in complex ways just beginning to be appreciated: biological/genetic pathways, individual risk factors, social relationships, neighborhoods, institutions, and social conditions and policies. We have written elsewhere4,5 that interventions that fail to take all levels into consideration may affect individual outcomes without making a dent in disparities at the population level.
In this presentation, we will outline a project that began on the Chicago's South Side and followed African-American women newly-diagnosed with breast cancer who were living in 15 predominantly African-American neighborhoods. An intervention plan was developed based on research in this and three other projects of the University of Chicago's Center for Interdisciplinary Research. The plan has been extended to African-American breast cancer survivors living in the City of St. Louis. Interventions with a range of community partners from community-based organizations, to the region's largest federally-qualified health center (People's Health Centers), to the St. Louis City Department of Health will be described that target the individual, neighborhood, and institutional levels of influence on African-American and white disparities in breast cancer mortality.
References:
1 DeSantis C, Ma J, Bryan L, Jemal A. Breast cancer statistics.Ca Cancer J Clin.2013; 64(1):52-62.
2 Hiatt RA, Porco TC, Balke K, Balmain A, Barlow J, et al. A multilevel model of postmenopausal breast cancer incidence. Cancer Epidemiol Biomarkers Prev. 2014;23(10):2078-92.
3 Warnecke RB, Oh A, Gehlert S, Lurie N, Rebbeck T, Paskett E, et al. Approaching health disparities from a population perspective: The NIH Centers for Population Health and Health Disparities. Am J Public Health, 2008;98:1608-15.
4 Gehlert S, Mininger C, Sohmer D, & Berg K. (Not so) gently down the stream: Choosing targets to ameliorate health disparities. Health & Social Work. 2008;33:163-7.
5 Gehlert S, & Colditz G. Cancer disparities: Unmet challenges in the elimination of disparities. Cancer Epidemiol Biomarkers Prev. 2011;20(9):1809-14.
Citation Format: Sarah Gehlert. Integrated multilevel interventions to address the African American and white disparity in breast cancer mortality. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA37.