Why does breast cancer strike African-American women harder? Start with social inequality

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Ellen Braunstein | Special to JT

October is Breast Cancer Awareness Month. In the United States, an African-American woman is about 40% more likely to die from breast cancer than a white woman, even though Black women are less likely to develop breast cancer.

(AaronAmat/iStock/Getty Images)

That’s one of the markers of racial disparity between Black and white women with the disease that kills 42,000 American women each year.

And while Black women have a lower lifetime risk, “racial disparities in breast cancer mortality exist even in patients participating in the same managed health care plan,” says Dr. Gretchen Gierach of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute in Bethesda, Md.

Black women have a 31% mortality rate due to breast cancer—the highest of any U.S. racial or ethnic group, reports the American Cancer Society.

About 12% of Black women get breast cancer, nearly the same rate as white women. But in Black women, the cancer tends to be more aggressive and at more an advanced-stage, even when it is diagnosed at a younger age.

Black women are twice as likely as white women to die of breast cancer if they are over 50, according to the U.S. Department of Health and Human Services, Office of Minority Health in Rockville, Md.

There are major risk factors in breast cancer affecting Black women and minorities.

Socioeconomic environment

Socioeconomic environment partially explains the racial disparities, says Dr. Wayne Lawrence, a research fellow at the Division of Cancer Epidemiology and Genetics at the National Cancer Institute.

“Black patients are more likely to experience poor communication with physicians,” he adds. This impacts treatment decision-making and ultimately outcomes.

Also contributing to a higher mortality rate may be “longer referrals, delays in treatment following a positive breast-cancer diagnosis and lower physician follow-up,” says greater medical mistrust and underuse of treatment as well as diagnoses at later stages,” says Lawrence.

One in seven Black women with breast cancer had delays in starting treatment, according to public health and cancer research conducted at University of North Carolina, Chapel Hill.

There is “greater medical mistrust” toward the medical establishment in the black community and an “underuse of treatment as well as diagnoses at later stages,” says Lawrence.

Financial hardship

“Financial hardship plays a role in delays, discontinuation and omission of treatment and thus may correlate with racial disparities in breast-cancer death,” according to the research conducted at UNC.

Lawrence says that “Black women are more likely to reside in lower-income areas with limited access to healthy food or limited ability to engage safely in physical activity. Additionally, these communities receive greater targeted marketing campaigns for cigarettes and alcohol compared to higher-income areas.”

Lawrence explains that people who reside in lower-income communities often are more likely to see a primary-care physician with limited clinical resources: “They experience greater barriers to accessing a breast-cancer specialist.”

Black women are more likely to reside in communities with greater exposure to environmental hazards linked to breast risk, says Lawrence.

They are more likely to receive inferior health care for cancer. More research is needed “to understand the role of the neighborhood socioeconomic environment plays in poor outcomes for breast cancer in Black women,” he adds.

Under-representation in studies

Black women have higher rates of triple negative breast cancer than white women that may be explained by gene variants found in Black women. “There are differences in the frequency of genetic variants across populations, including Black individuals,” says Dr. Brittany Lord, a postdoctoral research fellow at the Division of Cancer Epidemiology and Genetics at the National Cancer Institute in Shady Grove.

Black women have been underrepresented in studies to identify factors that could predispose them to developing aggressive forms of breast cancer. Current National Cancer Institute-funded efforts such as the African Ancestry Breast Cancer Genetic Consortium are addressing this important gap in knowledge, adds Dr. Montserrat Garcia-Closas, deputy director of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute in Shady Grove.

Lawrence concludes that more emphasis through research must be placed on understanding the contribution of social inequities to higher breast-cancer mortality rates among Black women.

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