Breast cancer may be killing black women at a higher rate than whites because they are sicker to start with, researchers reported on Tuesday.

Doctors and policymakers have known for years that African-American women are more likely to die of breast cancer than white women. Studies have offered all sorts of clues – there may be genetic differences, there may be disparities in getting medical care, black women may get inferior treatment, and blacks may simply avoid doctors more.

This latest study, done using a new method, shows not only that the differences are still there, years after experts first began to notice them — it also shows that black women are in poorer shape overall than whites when they are diagnosed.

“They come in sicker, with more advanced disease and more chronic conditions,” says Dr. Jeffrey Silber of the Children’s Hospital of Philadelphia, who led the study published in the Journal of the American Medical Association. “The disparity looks to be unchanged over the past few decades.”

The findings don’t surprise Karen Jackson, founder and CEO, of Sisters Network Inc., a Texas-based group that tries to educate and motivate African-American women about breast cancer. “After 20 years, I have seen this over and over again,” Jackson, who was treated for breast cancer 20 years ago, told NBC News.

“We know what the solutions are. Our initiatives are geared to early detection.”

Black women often fear a cancer diagnosis, and are afraid that they are doomed to die anyway, she said.

Jackson, who felt a lump for years before she was diagnosed, says she’s living proof that treatment works. But women have to actively seek care and they have to be vocal about getting the right kind of care.

Many experts have suspected that a combination of mistrust and difficulty in getting good medical treatment underlie many of the disparities seen in health. Blacks are more likely to die of a range of diseases, from diabetes to prostate cancer.

Silber’s team, armed with a grant from the Agency for Healthcare Research and Quality, set out to show what the differences really are.

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