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LETTER |
Correspondence: Requests for reprints should be sent to Nancy Krieger, PhD, Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (e-mail:nkrieger{at}hsph.harvard.edu).
Hall and Rockhill usefully urge researchers to pay attention to the complexities of the patterning of health by race/ethnicity and social class, for these patterns put our etiologic understanding to the test. In relation to breast cancer, they especially note the Black–White crossover in the age-specific incidence of this disease. This crossover has been documented in the United States since at least the 1940s (not just since 1973): in women younger than 40 years, breast cancer incidence is higher among African American women than among White women, but among women aged 40 years and older, rates are higher among White women.1 To date, there is no satisfactory explanation for this crossover.2,3
Pointing once again to the complexities of racial/ethnic and class disparities in health are the results of an earlier study I conducted on this topic.1 Among US women younger than 40 years, the incidence of breast cancer was highest among African American women living in more affluent areas and was equally low among African American and White women living in less affluent areas and White women living in more affluent areas. By contrast, among women aged 40 years and older, rates were equally high among African American and White women living in more affluent areas, lower among White women living in less affluent areas, and lowest among African American women in less affluent areas.
These complex patterns highlight why researchers analyzing breast cancer—or any disease—would do well to consider how the social realities of race/ethnicity and class interactively shape societal patterns of health, disease, and well-being. After all, we simultaneously live our race/ethnicity and social class (as well as our gender and sexuality), and our bodies daily embody and integrate these social realities. It would be useful if our research would aspire to do the same.4,5
References
1. Krieger N. Social class and the black/white crossover in age-specific incidence of breast cancer: a study linking census-derived data to population-based registry records. Am J Epidemiol. 1990;131:804–814.
2. Kelsey JL, Bernstein L. Epidemiology and prevention of breast cancer. Annu Rev Public Health. 1996;17:47–67.[Medline]
3. Krieger N. Exposure, susceptibility, and breast cancer risk: a hypothesis regarding exogenous carcinogens, breast tissue development, and social gradients, including black/white differences, in breast cancer incidence. Breast Cancer Res Treat. 1989;13:205–223.[Medline]
4. Krieger N, Rowley DL, Herman AA, Avery B, Phillips MT. Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am J Prev Med. 1993;9(suppl):82–122.[Medline]
5. Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30:668–677.
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