Impact of racial differences in medical care on breast cancer survival: Findings from a large nationwide and retrospective cohort study

Background: No studies have attempted to determine whether nodal surgery utilization, time to initiation and completion of chemotherapy or surveillance mammography impact breast cancer survival. ^ Objectives and Methods: To determine whether receipt of nodal surgery, initiation and completion of chemotherapy, and surveillance mammography impact of racial disparities in survival among breast cancer patients in SEER areas, 1992-2005. ^ Results: Adjusting for nodal surgery did not reduce racial disparities in survival. Patients who initiated chemotherapy more than three months after surgery were 1.8 times more likely to die of breast cancer (95% CI 1.3-2.5) compared to those who initiated chemotherapy less than a month after surgery, even after controlling for known confounders or controlling for race. Despite correcting for chemotherapy initiation and completion and known predictors of outcome, African American women still had worse disease specific survival than their Caucasian counterparts. We found that non-whites underwent surveillance mammography less frequently compared with whites and mammography use during a one- or two-year time interval was associated with a small reduced risk of breast-cancer-specific and all-cause mortality. Women who received a mammogram during a two-year interval could expect the same disease-specific survival benefit or overall survival benefit as women who received a mammogram during a one-year interval. We found that while adjustment for surveillance mammography receipt and physician visits reduced differences in mortality between blacks and whites, these survival disparities were eliminated after adjusting for the number of surveillance mammograms received. ^ Conclusions: The disparities in survival among African American and Hispanic women with breast cancer are not explained by nodal surgery utilization or chemotherapy initiation and chemotherapy completion. Surveillance mammograms, physician visits and number of mammograms received may play a major role in achieving equal outcomes for breast cancer-specific mortality for women diagnosed with primary breast cancer. Racial disparities in all-cause mortality were explained by racial differences in surveillance mammograms to certain degree, but were no longer significant after controlling for differences in comorbidity. Focusing on access to quality care and post treatment surveillance might help achieve national goals to eliminate racial disparities in healthcare and outcomes. ^

Risk and protective factors associated with depression among racial and ethnic mothers of adolescents

The central paradigm linking disadvantaged social status and mental health has been the social stress model (Horwitz, 1999), the assumption being that individuals residing in lower social status groups are subjected to greater levels of stress not experienced by individuals from higher status groups. A further assumption is that such individuals have fewer resources to cope with stress, in turn leading to higher levels of psychological disorder, including depression (Pearlin, 1989). Despite these key assumptions, there is a dearth of literature comparing the social patterning of stress exposure (Hatch & Dohrenwend, 2007; Meyer, Schwartz, & Frost, 2008; Kessler, Mickelson, & Williams, 1999; Turner & Avison, 2003; Turner & Lloyd, 1999; Turner, Wheaton, & Lloyd, 1995), and the distribution and contribution of protective factors, posited to play a role in the low rates of depression found among African- and Latino-Americans (Alegria et al., 2007; Breslau, Aguilar-Gaxiola, Kendler, Su, Williams, & Kessler, 2006; Breslau, Borges, Hagar, Tancredi, Gilman, 2009; Gavin, Walton, Chae, Alegria, Jackson, & Takeuchi, 2010; Williams, & Neighbors, 2006). Thus, this study sought to describe both the distribution and contribution of risk and protective factors in relation to depression among a sample of African-, European-, and Latina-American mothers of adolescents, including testing a hypothesized mechanism through which social support, an important protective factor specific to women and depression, operates. ^ Despite the finding that the levels of depression were not statistically different across all three groups of women, surprising results were found in describing the distribution of both risk and protective factors, in that results reported among all women who were mothers when analyzed masked differences within each ethnic group when SES was assessed, a point made explicit by Williams (2002) regarding racial and ethnic variations in women's health. In the final analysis, while perceived social support was found to partially mediate the effect of social isolation on depression, among African-Americans, the direct effect of social isolation and depression was lower among this group of women, as was the indirect effect of social isolation and perceived social support when compared to European- and Latina-American mothers. Or, put differently, higher levels of social isolation were not found to be as associated with more depression or lower social support among African-American mothers when compared to their European- and Latina-American counterparts. ^ Women in American society occupy a number of roles, i.e., that of being female, married or single, mother, homemaker or employee. In addition, to these roles, ethnicity and SES also come into play, such that the intersection of all these roles and the social contexts that they occupy are equally important and must be taken into consideration when making predictions drawn from the social stress model. Based on these findings, it appears that the assumptions of the social stress model need to be revisited to include the variety of roles that intersect among individuals from differing social groups. More specifically, among women who are mothers and occupy a myriad of other roles, i.e., that of being female, married or single, African- or Latina-American, mother, homemaker or employee, the intersection of all the roles and the social contexts that women occupy are equally important and must be taken into consideration when looking at both the types and distribution of stressors across women. Predictions based on simple, mutually exclusive categories of social groups may lead to erroneous assumptions and misleading results.^

Memorias de la 'Democracia racial brasileña'

La expresión 'Democracia racial' fue inventada en la década de 1930 por el famoso sociólogo brasileño Gilberto Freyre. Esta expresión contradictoria, si uno se remite a un concepto de ideal democracia con igualdad de derechos, sufrió en el debate académico y político dos grandes transformaciones. Más por ideología que por ambición intelectual, la expresión se anteponía originalmente al creciente fascismo brasileño de la dictadura de Getúlio Vargas (1930-1945). Un primer giro fue la adopción e imposición del discurso de tal supuesta democracia por la dictadura militar (1964-1985), que inclusive borró del censo la pregunta por el 'color' de la población. El segundo giro se dio en los años 1990 y llega hasta la actualidad en el contexto del multiculturalismo. Proponiendo un abordaje dialéctico de los marcos de la memoria de Maurice Halbwachs, el trabajo desarrolla esa historia intelectual pasando también por la obra de José Sazbón sobre las transformaciones y conflictos de la historiografía francesa en el contexto del bicentenario de la revolución (Furet, P. Nora, Sartre, Lévi-Strauss etc.). Por último se pretende mostrar los usos de la memoria y del olvido presentes en la imposición ideológica de ese supuesto ideal democrático, sobretodo en la discusión actual, donde el gobierno adoptó parcialmente la política de cuotas para afrodescendientes

Reseña del libro Crossing borders, claiming a nation. A History of Argentine Jewish Women, 1880-1955 de Sandra Mac Gee Deutsh

Fil: Bordagaray, María Eugenia. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

Reseña del libro Crossing borders, claiming a nation. A History of Argentine Jewish Women, 1880-1955 de Sandra Mac Gee Deutsh

Fil: Bordagaray, María Eugenia. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.

Memorias de la 'Democracia racial brasileña'

La expresión 'Democracia racial' fue inventada en la década de 1930 por el famoso sociólogo brasileño Gilberto Freyre. Esta expresión contradictoria, si uno se remite a un concepto de ideal democracia con igualdad de derechos, sufrió en el debate académico y político dos grandes transformaciones. Más por ideología que por ambición intelectual, la expresión se anteponía originalmente al creciente fascismo brasileño de la dictadura de Getúlio Vargas (1930-1945). Un primer giro fue la adopción e imposición del discurso de tal supuesta democracia por la dictadura militar (1964-1985), que inclusive borró del censo la pregunta por el 'color' de la población. El segundo giro se dio en los años 1990 y llega hasta la actualidad en el contexto del multiculturalismo. Proponiendo un abordaje dialéctico de los marcos de la memoria de Maurice Halbwachs, el trabajo desarrolla esa historia intelectual pasando también por la obra de José Sazbón sobre las transformaciones y conflictos de la historiografía francesa en el contexto del bicentenario de la revolución (Furet, P. Nora, Sartre, Lévi-Strauss etc.). Por último se pretende mostrar los usos de la memoria y del olvido presentes en la imposición ideológica de ese supuesto ideal democrático, sobretodo en la discusión actual, donde el gobierno adoptó parcialmente la política de cuotas para afrodescendientes

Memorias de la 'Democracia racial brasileña'

La expresión 'Democracia racial' fue inventada en la década de 1930 por el famoso sociólogo brasileño Gilberto Freyre. Esta expresión contradictoria, si uno se remite a un concepto de ideal democracia con igualdad de derechos, sufrió en el debate académico y político dos grandes transformaciones. Más por ideología que por ambición intelectual, la expresión se anteponía originalmente al creciente fascismo brasileño de la dictadura de Getúlio Vargas (1930-1945). Un primer giro fue la adopción e imposición del discurso de tal supuesta democracia por la dictadura militar (1964-1985), que inclusive borró del censo la pregunta por el 'color' de la población. El segundo giro se dio en los años 1990 y llega hasta la actualidad en el contexto del multiculturalismo. Proponiendo un abordaje dialéctico de los marcos de la memoria de Maurice Halbwachs, el trabajo desarrolla esa historia intelectual pasando también por la obra de José Sazbón sobre las transformaciones y conflictos de la historiografía francesa en el contexto del bicentenario de la revolución (Furet, P. Nora, Sartre, Lévi-Strauss etc.). Por último se pretende mostrar los usos de la memoria y del olvido presentes en la imposición ideológica de ese supuesto ideal democrático, sobretodo en la discusión actual, donde el gobierno adoptó parcialmente la política de cuotas para afrodescendientes

Reseña del libro Crossing borders, claiming a nation. A History of Argentine Jewish Women, 1880-1955 de Sandra Mac Gee Deutsh

Fil: Bordagaray, María Eugenia. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales (UNLP-CONICET); Argentina.