Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975–2001

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Abstract
Purpose This study examined whether race/ethnicity had differential effects on breast cancer care and survival across age strata and cohorts within stages of disease. Methods The Detroit Cancer Registry provided 25,997 breast cancer cases. African American and non-Hispanic white, older Medicare-eligible and younger non-eligible women were compared. Successive historical cohorts (1975–1980 and 1990–1995) were, respectively, followed until 1986 and 2001. Results African American disadvantages on survival and treatments increased significantly, particularly among younger women who were much more likely to be uninsured. Within node positive disease all treatment disadvantages among younger African American women disappeared with socioeconomic adjustment. Conclusions Growth of this racial divide implicates social, rather than biological, forces. Its elimination will require high quality health care for all.