One striking example of the disparity between races: The five-year survival rate for black women with breast cancer is 70 percent, while for white women it’s 85 percent, according to the American Cancer Society. Experts point to several possible explanations. "There are some individual factors. There are some societal factors. There are probably some biological differences that need to be teased out," said Janice Mitchell Phillips, PhD, RN, an assistant professor at the University of Maryland School of Nursing at Baltimore, who researches breast cancer screening in black women. She thinks that while individual factors play their part, "we need to take a look at some systems and some institutional issues as well."

Cultural beliefs often shape women’s willingness to do self-exams and get screenings. Some women come from cultures that consider it inappropriate for women to touch or look at their own breasts, said Sandra Millon Underwood, PhD, RN, FAAN, a professor at the University of Wisconsin-Milwaukee School of Nursing who researches cancer prevention in relation to minority populations. Fatalistic attitudes play a part, too. Many black women believe that breast cancer inevitably ends in a mastectomy and death, Underwood said, so they’re less likely to get screened or examine themselves.

In addition, minority women are less likely to be well-educated, so they may be more vulnerable to fear and superstition, say cancer experts.

For example, some American Indian women won’t even talk about the disease for fear that they will contract it, said advanced oncology certified nurse Jeannine M. Brant, RN, an oncology clinical nurse specialist who works with many American Indian women at St. Vincent Hospital and Health Center in Billings, Mont. In general, women with lower educational levels neglect preventive activities such as annual well-woman exams, said Alice F. Judkins, RN, a nurse in breast surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

Poverty also plays a role, and nonwhite women are more likely to be poor. Getting a mammogram is often the last thing on the mind of a woman who can’t even afford health insurance. In addition, many low-income women lack transportation, a problem shared by rural and inner-city patients alike. M.D. Anderson tackles this problem by dispatching screening vans to grocery-store parking lots in an effort to make screening available, affordable, and visible, Judkins said.

But the differences in mortality rates aren’t entirely attributable to a lack of screening, said Underwood, who noted that regardless of income, the length of time between diagnosis and treatment is far longer for black women than for other groups. Healthcare providers have to consider the possibility that ethnic minorities are not receiving the same quality of care as whites, say cancer experts.

Race makes a difference in treatment, said Marjorie Kagawa-Singer, PhD, MN, RN, who teaches the cross-cultural aspects of health care at the UCLA School of Public Health in Los Angeles. "Several minority researchers have demonstrated statistically that when you control for socioeconomic level and look at within-group differences, those discrepancies still exist to a statistically significant level. They are beginning to be able to document that it’s more than just class issues, access, and affordability of health care."

Healthcare professionals should become aware of their own attitudes and how they unconsciously affect their communications, Kagawa-Singer advised. Most providers are white and may not realize that they are sending negative cues in spite of good intentions, she said.

And most of all, they need to remember that they can help, Phillips said. "Nurses are really on the front lines to get the word out and make a difference."