The differences in access, process, and structure of healthcare among specific population groups. A geographic health care disparity may occur in that those living in urban areas may have easier access to certain types of healthcare than those living in rural areas. In another example, people who do not speak English well may not get the same level of care as those who do speak English, due to barriers in communication. Health care disparities can lead to health disparities in some cases. For example, African American women suffering from breast cancer are less likely to receive follow up radiation treatment after breast conserving surgery. In a project published last year, this health care disparity was shown to be responsible for a large part (but not all) of the difference in survival between African American and Caucasian women with breast cancer. The researcher found that when African American and Caucasian women received the same care (i.e., radiation therapy following breast conserving surgery), the difference in survival between the two groups was significantly less. (Source: Joslyn SA. Racial Differences in treatment and survival from early-stage breast carcinoma. Cancer 2002 Oct 15;95(8):1759-66) In other cases, health care disparities do not lead to health disparities. This was found within the VA health care system where the survival after heart attack was the same for Caucasian and African American men, despite the fact that African American men did not receive the same types of treatments as the Caucasian veterans. (Source: Petersen LA, Wright SM, Peterson ED, Daley J. Impact of Race on Cardiac Care and Outcomes in Veterans With Acute Myocardial Infarction. Medical Care (supplement). 2002;40:I86-96. )