It's Not Black and White: Racial Disparities in Breast Cancer
Breast cancer is a kick in the gut to any of us who’ve been through it. The devastation when you learn you have the disease; the onerous treatment; the loss of a breast or breasts, all can make moving forward both bleak and disheartening.
Think, then, how much tougher breast cancer can be for black women. According to the National Cancer Institute (NCI), black women are often diagnosed when their cancer is more advanced; have a higher incidence of aggressive subtypes of the disease; and are more likely to die of their cancer than their white sisters: 42 percent more likely, according to the American Cancer Society (ACS).
Since the government started tracking breast cancer incidence in 1973, white women had always been diagnosed with breast cancer at a higher rate than black women. But ACS statistics show that as of 2012, black women are just as likely as white women to receive a breast cancer diagnosis. And the rate of diagnosis for African Americans continues to grow, while for white women, it remains stable.
Why do black women have more aggressive breast cancers? Why aren’t they caught earlier? Why are African Americans less likely to survive? Is it genetic, lifestyle-related, or societal?
The answer would seem to be, “all three.”
Genetically, black women are diagnosed with both inflammatory breast cancer and triple negative breast cancer twice as often as white women. Both cancers are highly aggressive; both are deadlier than all other types of breast cancer. In addition, black women are diagnosed with breast cancer at an earlier age, when it’s more likely to prove fatal.
Socioeconomic status and lifestyle are inextricably entwined, and these too seem to play a role in black women’s lower breast cancer survival rates. A woman without health insurance is less likely to see a doctor when she discovers a lump in her breast; and even if she has medical coverage, she may live in an area without access to immediate or highly competent care.
Underserved women are often unable to follow a healthy diet; aside from lack of money for groceries, access to fresh fruits and vegetables may be limited. A poor diet encourages obesity; and being overweight is an established breast cancer risk factor. In addition, a woman without access to regular health care will often suffer from other health conditions, some of which can increase the likelihood she’ll die of breast cancer.
What can we do, as a society, to end the disparity between black and white women when it comes to breast cancer outcomes?
We can begin by recognizing and validating the problem — which researchers have done. Black women can be made aware of their heightened risk, through better education via grassroots community outreach efforts. And as a start toward eliminating the disparity in breast cancer outcomes between black and white women, we can determine the root causes that lead to this disparity — a quest that’s actually begun.
The NCI announced in July 2016 that it was launching a new study, the Breast Cancer Genetic Study in African-Ancestry Populations, a meta-analysis billed as “the largest-ever study of breast cancer genetics in black women.” The effort will aggregate 18 previous studies and involve data from over 20,000 black women with breast cancer.
The study’s desired outcome? “[Advancing] our understanding of the social and biological causes that lead to disparities in cancer among underserved populations.”
Identify. Investigate. Address. This is how problems are solved. And this is the path to breast cancer in America truly becoming an equal-opportunity experience.
Breast cancer survivor and award-winning authorPJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.