Breast cancer is the commonest cancer in women in UK and is the commonest cause of death in the 35-55 age group. (Nursing Times; 91(8); Feb 22; 1995;).

  Breast cancer has a prevalence of 116.59 cases/100,000 population in SE England with cancer survival in Britain being poorer than that of her comparable European neighbours.

  Cancer survival has been clearly linked to socio-economic status. Cancer has been described as a lottery with an unequal chance of winning due to socio-economic disparities. Over 12,700 deaths could be avoided every year if all patients shared the survival rates of the most affluent patients.

  Black women have lower 5-year breast cancer survival. Income influences breast cancer survival differences (Cancer; 72(10); 1993; 2974-8).

  Median survival in Ca Breast: Whites 7.5 years, Blacks 5-6 years (Breast Cancer Res Treat; 9(2); 1987; 135-43).

  Cancer is a major killer of people from black and ethnic minority groups. The cultural, linguistic and religious backgrounds these people have may result in them having different expectations and experiences of services from their white counterparts. An appreciation of these factors is therefore essential in planning and development of cancer services for different ethnic groups.

  The incidence of breast cancer is higher among White women, but mortality was higher among African-American women—(Environ Health Perspect; 103(S8); 1995; 275-281).

  Increasing Black:White gap in mortality due to breast cancer; National trends in US between 1976-1996:

  3 per cent decrease in mortality in White women, 18 per cent increase in mortality in Black women (World Medical Journal; 98(3); 1999; 37-9).

  Ethnic minorities constitute 6 per cent of the total population in UK and Wales; just under a half are from the Indian sub-continent, one third are Afro-Caribbean or African and 5 per cent are Chinese.

  White women with breast cancer had better survival rates than their Black counterparts—(Am J Obstet & Gynae; 1997; S229).

  Significant survival difference between black and white female breast cancer patients—1.63 times higher risk of mortality.—(Cancer; 78(6); 1996; 1241-7).

  African-American women in US have significantly worse breast carcinoma survival than do their white counterparts. The incidence rates of breast carcinoma are increasing more rapidly in African-Americans than in any other racial/ethnic group in the US. The relative risk of dying from breast cancer in African-Americans compared to whites was 1.68 (95 per cent CI)—(Am J Obstet Gynaecol; 176; 1997; S-2339).

  Black patients with breast cancer less likely to survive than Whites and Hispanics—A Multivariate Analysis (Cancer; 55(7); 1985; 1563-71).

  Most women of Afro-Caribbean origin have buried their heads in sands over this issue (BMA News Review, Oct 1998).

  Poor doctor-patient communication due to socio-cultural and language barriers. Little information or resources for Asian women who were unable to speak English (Nursing Times—A study done on 48 Asian women).

  Lower prevalence rates of screening mammograms in ethnic minority women. The most common reason for not having it was that the doctor did not recommend a mammogram!

MULTI-FACTORIAL ISSUE:

Socio-economic factors

—  Educational disparities;

—  Economic status disparities;

—  Cultural barriers and taboos;

—  Communication barriers.

Nutritional factors

Biological factors

—  Increased poorly differentiated types;

—  Increased High Grade tumours;

—  Increased Hormone receptor negative;

—  Alterations in p53genes;

—  Differences in Cytochrome p450 enzyme systems.

Clinical factors

—  Increased late stage presentations;

—  Increased average tumour size;

—  Increased lymph node positives. (Am J Obstet Gynaecol 1997.)

System delay

—  Longer in Blacks (Am J Epidemiol, 1995; 142(8); 804-12.)

  In summary, the assessment of the health and social needs of any given population (or a group of that population) is an essential and integral part of delivering high quality and effective health care to maintain and improve the health of that population or the targeted group.

June 2000