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1.  Breast cancer epidemiology in blacks and whites: disparities in incidence, mortality, survival rates and histology 
This study presents black-white breast cancer statistics, tumor histology and receptor status, and treatment patterns for all ages and by age groups (under 40, between ages 40 and 49, and age 50 and over).
The study used data from the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) program for the time period 1995–2004. Age-adjusted incidence, mortality, relative survival rates, tumor grade, histology and receptor status, and treatment patterns for invasive breast cancer were calculated for nine SEER cancer registries for 1995–2004.
Invasive breast cancer age-adjusted incidence for black women age <40 was significantly higher than those for white women (rate ratio=1.16, 95% confidence interval=1.10–1.23). Age-adjusted mortality rate for black women age <40 was twice that for white women. Compared to white women, black women were significantly more likely to be diagnosed with regional or distant disease, have lower relative five-year survival rate, and have higher likelihood of being diagnosed with tumors with poorer prognosis. Black women were less likely to receive breast cancer surgery as part of the treatment plan.
Race/ethnic disparities in invasive breast cancer epidemiology, prognostic indicators, and treatment patterns exist between black and white women. The study findings support the need for innovative research, especially on the multifaceted determinants of the differential epidemiology of breast cancer. Equally importantly, there is a need for evidence-guided equal delivery of quality care to eliminate breast cancer disparities among black women.
PMCID: PMC3603001  PMID: 18507200
breast cancer; minority health; mortality; survival; receptor; tumor
2.  Recruitment and Participation In Clinical Trials: Socio-Demographic, Rural/Urban, and Health Care Access Predictors 
Recruitment and participation in clinical trials by minorities, particularly African Americans and rural underserved populations, are low. This report examines predictors of clinical trial recruitment and participation for adult Marylanders.
A cross-sectional design was used to survey 5,154 adults (18 years and older) residing in 13 of the 24 jurisdictions in Maryland, including urban Baltimore City, and the rural regions of Western Maryland and the Eastern Shore. The survey, conducted between December 2001 and March 2003, used Computer-Assisted Telephone Interviewing and random-digit dialing procedures. Primary dependent variables included “ever asked to participate” (i.e., recruited) and “participated” in clinical trials.
11.1% of the respondents had been recruited to clinical trials. In addition, 59.4% of the respondents recruited to clinical trials actually participated in a clinical trial. Among respondents recruited to clinical trials, black and middle income respondents were significantly less likely to actually participate in clinical trials; whereas, respondents who received information about clinical trials from their health care provider, who were knowledgeable about clinical trials, and those who had the time commitment were significantly more likely to participate in clinical trials.
These results suggest serious gaps in efforts to recruit racial/ethnic minorities and residents of rural regions into clinical trials. The findings provide the basis for the development and implementation of community-based educational programs for both the general public and health care professionals, and to enhance availability of community-based clinical trials, especially in the rural areas of the state.
PMCID: PMC3276312  PMID: 16495020
clinical trial; cancer disparities; patient selection; research participant recruitment; patient participation; rural or urban population; minority groups; neoplasm; knowledge; attitudes; source of information
3.  Clinical Trials – The Art of Enrollment 
Seminars in Oncology Nursing  2008;24(4):262-269.
Enrollment barriers and multidisciplinary approaches to increase cancer trials participation are presented. Recruitment barriers, research in Maryland, and a Best Practice for cancer trials are discussed.
Data Sources
Journal and research articles, web sites.
Clinical trials have produced prevention and care advances for cancer and other diseases. Trial enrollment is lower for minorities and underserved communities. A comprehensive program for addressing enrollment barriers should incorporate research on barriers, multidisciplinary teams, and education and trial infrastructure in community settings.
Implications for Nursing Practice
Health disparities training, including culturally appropriate enrollment approaches for education and retention of underserved communities, should incorporate community stakeholders and nurse/physician researchers.
PMCID: PMC3262589  PMID: 19000600
clinical trials enrollment; barriers; accrual; minority and underserved
5.  Esophageal cancer epidemiology in blacks and whites: racial and gender disparities in incidence, mortality, survival rates and histology. 
BACKGROUND: Esophageal cancer rate disparities are pronounced for blacks and whites. This study presents black-white esophageal cancer incidence, mortality, relative survival rates, histology and trends for two five-year time periods--1991-1995 and 1996-2000--and for the time period 1991-2000. METHODS: The study used data from the National Cancer Institute's population-based Surveillance Epidemiology End Results (SEER) program with submission dates 1991-2000. Age-adjusted incidence, mortality, relative survival rates and histology for esophageal carcinoma were calculated for nine SEER cancer registries for 1991-2000. Rates were analyzed by race and gender for changes over specified time periods. RESULTS: Esophageal cancer age-adjusted incidence of blacks was about twice that of whites (8.63 vs. 4.39/100,000, p < 0.05). Age-adjusted mortality for blacks, although showing a declining trend, was nearly twice that of whites (7.79 vs. 3.96, p < 0.05). Although survival was poor for all groups, it was significantly poorer in blacks than in whites. Squamous cell carcinoma was more commonly diagnosed in blacks and white females, whereas adenocarcinoma was more common among white males (p < 0.001). CONCLUSIONS: Racial disparities in esophageal cancer incidence, mortality, survival and histology exist. Survival rates from this disease have not significantly improved over the decade. These data support the need for advances in prevention, early detection biomarker research and research on new, more effective treatment modalities for this disease.
PMCID: PMC2594901  PMID: 16334494

Results 1-5 (5)