African-American women have fewer cases of breast cancer than white women, but die more frequently from the disease. For years, the reason was thought to be poor access to screening and health care, in large part because of poverty.

But according to a recent article in Cancer (Vol. 94, No. 11: 2844-2854), that may not be the whole story.

Lisa Newman, MD, from the Karmanos Cancer Institute in Detroit, and her colleagues found that African-American women also had more cancers diagnosed at a younger age, which has a worse outlook. They also had more cancers that were not hormone sensitive, another sign of poor outcome.

The researchers asked if it could be that breast cancer behaves differently in African-American women compared to white women. They wanted to know if it is possible that there may some link to heritage, and that poverty and poor access to care alone are not the only reasons these women die more frequently from breast cancer.

Newman and her colleagues looked at other articles about the outcomes of African-American and white women with breast cancer. They were able to find information on 10,000 African-American women, and more than 42,000 white women.

Next, they screened the information on these women for their stage of breast cancer and their socioeconomic status.

After looking at the results, the authors reported that all of the studies showed African-American women did worse than white women with breast cancer.

When taking socioeconomic status into account, the difference in outcomes was reduced. But there was still a difference. This meant that poverty alone was not the reason African-American women had more deaths from breast cancer.

There was something different about the way the disease behaved in these women, and race may have been a factor in that difference.

The authors concluded that race alone, aside from the effects of being poor, increased the death rates for African-American women about 20% compared to white women.

Even when African-American women were treated in health care systems with equal access, such as the military, there was a 35% increased chance of dying from breast cancer.

This doesn't mean that poverty doesn't play a role — it can. It shows that poverty alone isn't the only reason African-American women have higher death rates from breast cancer.

As the authors noted, "The results of this (analysis) should not minimize the importance of attempting to remedy the socioeconomic disadvantages that are more prevalent among African Americans.

"Proactive legislation that expands employment opportunities, improves housing standards, and increases health care access for the poor are necessary and essential items that should be kept high on the public policy agenda," they said.