Equal access, unequal outcomes? racial disparities in mortality between black and white women with breast cancer: a 10-year systematic review and meta-analysis

Purpose: This study uses systematic review and meta-analysis to address whether the significant disparities in breast cancer (BC) related health outcomes between Black and White women in the U.S. exist for women treated in the equal access Military Health System (MHS). Methods: PubMed, CINAHL, and Web of Science were searched using PRISMA guidelines in February–March 2024 for articles published between 2014–2024 containing quantitative mortality outcomes for Black and White women with BC treated in the MHS. Summarized mortality risk was computed using random effects meta-analysis from 2 × 2 tables of total deaths and population. Search, study selection, and quality assessment were completed by two independent co-authors. Results: Six studies with samples ranging from 395 to 28,818 across 31 years of data were included, and their mortality findings synthesized. Compared to matched patients in the general population, both Black and White women treated in the MHS had reduced mortality risk in two studies. While unadjusted mortality risk varied across three studies with direct comparisons between Black and White women treated in the MHS, adjusting for demographic and cancer characteristics eliminated significant differences. Meta-analysis of all six studies revealed a higher pooled unadjusted mortality risk for Black compared to White women (OR: 1.20, 95% CI: 1.09–1.33). Conclusions: Equal access to health care alone may not eliminate racial disparities in mortality for patients with BC. Implications for Cancer Survivors: Improving access, in combination with other targeted interventions, may reduce disparities in health outcomes for women with BC.